Zelis · 2 days ago
DRG Validation Manager
Wonder how qualified you are to the job?
Maximize your interview chances
FinanceFinTech
Actively Hiring
Insider Connection @Zelis
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
Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.
Required
Registered Nurse licensure required
Inpatient Coding Certification required (i.e., CCS, CIC, RHIA, RHIT)
5 - 7 years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims required
Solid understanding of audit techniques and identification of revenue opportunities
Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs
Strong understanding of hospital coding and billing rules
Clinical and critical thinking skills to evaluate appropriate coding
Experience conducting root cause analysis and identifying solutions
Strong organization skills with attention to detail
Outstanding verbal and written communication skills
Preferred
Supervisory experience preferred
Benefits
Health Insurance
Company
Zelis
Zelis is modernizing the healthcare financial experience for all.
Funding
Current Stage
Late StageTotal Funding
$20.15M2020-01-05Private Equity· $20.15M
2019-01-01Private Equity· Undisclosed
Leadership Team
Recent News
Business Wire
2024-05-20
Company data provided by crunchbase