About the role

  • Manager leading a high-performing team in auditing inpatient records for DRG assignments. Collaborating cross-functionally to support regulatory integrity and identify coding discrepancies.

Responsibilities

  • Sets the strategic direction for audit methodologies, oversees team development, and ensures that audits meet the industry’s best practices and payer-specific requirements.
  • Collaborates cross-functionally with clinical, compliance, provider engagement, and data analytics teams to align audit insights with broader program goals.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.
  • Analysis of audit trends, DRG shifts, and using financial outcomes to inform strategy.
  • Plans program/project scope and design.
  • Develops metrics and program/project reporting tools.
  • Analyzes variance to program/project plan.
  • Leads building of documentation to support business objectives and ensure consistency.
  • Responsible for championing local stakeholders and tactical decision-makers.
  • Suggests and develops high quality, high value concept and or process improvement and efficiency recommendations.
  • Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions.

Requirements

  • Requires a BA/BS and minimum of 5 years experience in project/program management, process reengineering, organizational design, and/or implementation; or any combination of education and experience, which would provide an equivalent background.
  • Preferred experience includes a minimum of 5-7 years of inpatient coding or DRG auditing experience, including 2-3 years in a leadership or supervisory capacity.
  • Experience working with ICD-9/10CM, MS-DRG and APR-DRG.
  • Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology preferred.

Benefits

  • comprehensive benefits package
  • incentive and recognition programs
  • equity stock purchase
  • 401k contribution
  • merit increases
  • paid holidays
  • Paid Time Off
  • medical benefits
  • dental benefits
  • vision benefits
  • short and long term disability benefits
  • stock purchase plan
  • life insurance
  • wellness programs
  • financial education resources

Job title

Manager, DRG Coding Audit

Job type

Experience level

Mid levelSenior

Salary

$111,040 - $199,872 per year

Degree requirement

Bachelor's Degree

Location requirements

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