DRG Quality Manager

ExlService Holdings, Inc.; Northern (KY); Hybrid; USD 100,000 - 120,000; Full time

Job summary

ExlService Holdings, Inc. is seeking a leader to manage a team of DRG quality analysts responsible for reviewing auditor-completed MS-DRG and APR-DRG work, validating audit accuracy, and ensuring accurate coding and reimbursement outcomes.

The role may oversee additional quality specialties within clinical or coding audit programs, requiring strong leadership and analytical skills, with expertise in Coding Guidelines, Coding Clinic, audit tools, CMS regulations, payer requirements, and quality

Qualifications

• Experience leading DRG quality teams.
• Strong leadership and analytical skills.
• Expertise in Coding Guidelines and Coding Clinic.
• Solid understanding of CMS regulations and payer requirements.

Responsibilities

• Direct and develop a team of DRG quality analysts.
• Review auditor-completed MS-DRG and APR-DRG work.
• Validate audit accuracy and coding reimbursement outcomes.
• Oversee additional quality specialties in audit programs.
• Collaborate with CMS compliance and payer teams.
• Participate in interviews and process improvements.

Skills

Leadership

Analytical skills

CMS guidelines

Coding Clinic

Audit tools

Quality governance

Regulatory knowledge

Job description

The role directly manages a team of DRG quality analysts responsible for reviewing auditor-completed MS-DRG and APR-DRG work, validating audit accuracy, and ensuring accurate coding and reimbursement outcomes. This leader may also oversee additional quality specialties within clinical or coding audit programs. The ideal candidate demonstrates strong leadership and analytical skills, along with expertise in Coding Guidelines, Coding Clinic, audit tools, and a solid understanding of CMS regulations, payer requirements, and quality governance.

Salary Range: $100,000 – $120,000, based on experience, skills, and qualifications.

Location: 100% Remote, U.S.-based.

Travel: Limited travel may be required for team meetings.

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.