Zelis · 2 days ago

DRG Validation Manager

Boston, MA

Full-time

Hybrid

Mid, Senior Level

5+ years exp

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Responsibilities

Oversee the DRG validation process including management of claim assignment and queues, adherence to client turnaround time and department procedures

Serve as the Subject Matter Expert on DRG validation to team members and other departments within the organization

Lead and manage a team of coding professionals by providing guidance, training, and support to encourage a positive and collaborative team culture

Monitor key performance indicators to track team productivity and accuracy, client and concept trends and implement improvement strategies

Implement and conduct quality assurance program to ensure accurate results to our clients

Collaborate with Product, IT, Implementation and Sales teams to drive growth initiatives and outcomes

Assist in dispute process and defense of denials as necessary

Must remain current in all national coding guidelines including Official Coding Guidelines, AHA Coding Clinic and AMA CPT Assistant

Participate in client facing meetings as necessary

Identify new DRG coding concepts to drive growth opportunities.

Recommend efficiencies and process improvements to improve departmental procedures

Maintain awareness of and ensure adherence to Zelis standards regarding privacy

Qualification

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Registered nurse licensureInpatient coding certificationIcd-10 cmMs-drgApr-drgAudit techniquesRevenue opportunities identificationHealth insurance knowledgeMedicare guidelines knowledgeHealthcare programs knowledgeHospital coding rules knowledgeBilling rules knowledgeRoot cause analysisProblem-solvingCritical thinkingCommunicationOrganizationSupervisory Experience