Senior APR-DRG Concept & Analytics Lead

EXL; Oregon; Hybrid; USD 100.000 - 125.000; Vollzeit

Benefits dieser Stelle

Healthcare

Vision

Dental

401k

Zusammenfassung

EXL Health is seeking an APR DRG Concept Development Analyst to collaborate with Payment Integrity Audit program leaders and DRG audit professionals to research, develop and implement inpatient DRG audit criteria. The role emphasizes mastery-level ICD-10-CM/PCS coding and APR-DRG methodologies, with a focus on quality and analytical rigor.

The position includes a salary range of $100,000–$125,000 and may involve an interview assessment. Benefits information is available on our site.

Qualifikationen

• Bachelor's degree in health information management, Healthcare Informatics or Health Care Administration.
• Active AHIMA certification - RHIA, RHIT or CCS.
• 10+ years of inpatient coding or auditing experience with mastery in APR-DRG methodology.
• Experience developing audit selection criteria to identify APR-DRG coding errors and overpayments.

Aufgaben

• Subject matter expert for research, analysis and generation of new concepts and selection rules to identify overpayment opportunities in APR-DRG validation.
• Collaborates with audit and analytic teams to review concepts pre-and post-implementation to monitor performance.
• Build queries and concepts, test concept effectiveness using internal selection tools.
• Deliver results and insights to senior leaders.
• Adjust selection criteria based on client requirements.
• Responsible for monthly claim screening and selection.
• Verify selections output to ensure rules function as intended.
• Review appeals/disputes to identify areas for improvement.
• Create education/training documents and conduct handoff meetings with Audit teams.
• Ensure clinical team is calibrated with client policies and internal concepts.
• Utilize Audit Outcome trend reports to monitor and fine tune queries.

Kenntnisse

APR-DRG mastery

ICD-10-CM coding

ICD-10-PCS coding

Data analysis

Audit concepts

Communication skills

Ausbildung

Bachelors in HIM/Health Informatics/Healthcare Admin

AHIMA RHIA/RHIT/CCS certification

Tools

3M Encoder

TruBridge

Excel

PowerPoint

AI tools

Jobbeschreibung

EXL Health is seeking an APR DRG Concept Development Analyst to collaborate with Payment Integrity Audit program leaders and DRG audit professionals to research, develop and implement inpatient DRG audit criteria. The role emphasizes mastery-level ICD-10-CM/PCS coding and APR-DRG methodologies, with a focus on quality and analytical rigor.

The position includes a salary range of $100,000–$125,000 and may involve an interview assessment. Benefits information is available on our site.