Diagnosis-Related Group (DRG) Manager

Ex; United States; Remote; USD 100,000 - 120,000; Full time

Job summary

Ex offers a DRG Manager role that leads planning, coordination, and execution of DRG audit activities, ensuring client SLAs and operational goals are met. This role directs a team of auditors responsible for MS-DRG and APR-DRG reviews to assure accurate coding and reimbursement outcomes.

Ideal candidates demonstrate strong leadership and analytical skills, with expertise in Coding Guidelines, Coding Clinic, and audit tools, and a solid understanding of CMS regulations and payer requirements.

Qualifications

• Strong leadership and analytical skills are required.
• Expertise in Coding Guidelines and Coding Clinic.
• Experience with audit tools and CMS/payer requirements.

Responsibilities

• Lead planning, coordination and execution of DRG audit activities.
• Oversee inventory, aging, risks and day-to-day performance.
• Direct a team of auditors responsible for MS-DRG and APR-DRG reviews.
• Collaborate cross-functionally to support program success.

Skills

Leadership

Analytical skills

Coding guidelines

Audit tools

CMS regulations

Payer requirements

Tools

MS-DRG reviews

APR-DRG reviews

Coding Clinic

Job description

The DRG Manager leads the planning, coordination, and execution of DRG audit activities, ensuring teams meet client SLAs and operational goals. This role oversees inventory, aging, risks, and day-to-day performance, while collaborating cross-functionally to support program success.

The role directly manages a team of auditors responsible for MS-DRG and APR-DRG reviews, ensuring accurate coding and reimbursement outcomes. The ideal candidate demonstrates strong leadership and analytical skills, along with expertise in Coding Guidelines, Coding Clinic, and audit tools, and a solid understanding of CMS regulations and payer requirements.

Salary Range: $100,000 – $120,000 (based on experience, skills, and qualifications) Location: 100% Remote (U.S.-based)

Up to 10% annual travel (for team meetings and limited client onsite engagements.)

A brief coding/auditing assessment may be included as part of the interview process.

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

The posted range is the hiring range for this role — a subset of the broader range available to employees over time — and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.