Remote DRG Quality Manager | Lead Audit Excellence

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

Benefits offered by this job

Healthcare

Vision

Dental

401(k)

Job summary

EXL is seeking a DRG Quality 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 partners with technology, operations, and training to support audit quality solutions, oversees daily QA operations, and drives improvement initiatives while ensuring SLA, productivity, and quality standards. 100% remote, U.S.-based with some travel.

Qualifications

• Active coding credential (CCS, RHIT, RHIA, or CPC).
• 5–8 years MS-DRG/APR-DRG experience with ICD-10-CM/PCS knowledge.
• Prior leadership experience overseeing DRG quality analysts or similar teams.
• Strong understanding of DRG reimbursement methodologies.
• Knowledge of CMS regulations and payer guidelines.
• Experience in audit, payment integrity, or coding quality review.
• Strong analytical and decision-making abilities.
• Effective verbal and written communication.

Responsibilities

• Support DRG quality review programs, including readmissions and place of service reviews.
• Partner with cross-functional teams to implement audit quality solutions.
• Oversee day-to-day quality review operations meeting SLAs and quality standards.
• Manage QA inventory, workflow, aging, and productivity.
• Supervise DRG quality analysts and coach others as needed.
• Ensure adherence to productivity, quality, accuracy, and SLAs.
• Monitor regulatory and payer guideline updates for compliance.
• Support performance management and staff development.
• Identify gaps and drive improvement initiatives.
• Escalate and help resolve client, quality, or operational issues.
• Support reporting on productivity, quality, audit accuracy, metrics.
• Assist with program implementations by defining quality criteria and controls.
• Ensure consistency across analysts, programs, Operations, Training, and partners.
• Facilitate ongoing development and upskilling of analysts.

Skills

Leadership

Analytical skills

DRG expertise

Communication

Attention to detail

Multi-tasking

Interpersonal skills

MS Office & dashboards

Education

Coding credential (CCS/RHIT/RHIA/CPC)

Tools

Audit/reporting systems

Microsoft Office

Dashboards

Job description

EXL is seeking a DRG Quality 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 partners with technology, operations, and training to support audit quality solutions, oversees daily QA operations, and drives improvement initiatives while ensuring SLA, productivity, and quality standards. 100% remote, U.S.-based with some travel.