DRG Quality Manager

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

Job summary

ExL Service seeks a senior 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 supervise additional quality areas within clinical or coding audit programs, requiring strong leadership and analytical skills and deep CMS regulatory knowledge.

Qualifications

• Experience leading a quality or auditing team in healthcare.
• Strong knowledge of DRG/APR-DRG processes and coding guidelines.
• Familiarity with Coding Clinic, CMS and payer requirements.

Responsibilities

• Directly manage a team of DRG quality analysts reviewing auditor work.
• Validate audit accuracy and ensure correct coding and reimbursement outcomes.
• Oversee additional quality specialties within coding audit programs as needed.

Skills

Leadership

DRG auditing

CMS regulations

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.