Senior DRG Analytics Lead - Health Claims

EXL Talent Acquisition Team; United States; On-site; USD 120,000 - 125,000; Full time

Job summary

EXL Service is seeking a Senior Manager DRG SME to support evaluation of utilization trends in health care data and develop cost-effective, quality products/services. The role focuses on MS-DRG/APR-DRG payment systems and claims experience across inpatient and outpatient settings. Candidates should be proactive, independent, and able to work in a fast-paced environment.

Salary ranges from $120k to $125k, with benefits. Visit EXL's careers page for more information.

Qualifications

• Extensive experience analyzing health care claims and DRG data.
• Strong understanding of inpatient MS-DRG and APR-DRG payment systems.
• Experience with outpatient, home health, SNF, behavioral health, IRF, professional services, DME, and HCD claims is a plus.
• Experience with payer policy, claim systems limitations, and provider contracting terms recommended.
• Experience with pre-pay and post-pay code edits/rules development encouraged.

Responsibilities

• Evaluate trends in care management, claim utilization, and member attributes to develop cost-effective quality products/services.
• Retrieve, organize, and analyze medical health claim data to identify root causes.
• Collaborate with business teams in a fast-paced environment and communicate findings clearly.

Job description

EXL Service is seeking a Senior Manager DRG SME to support evaluation of utilization trends in health care data and develop cost-effective, quality products/services. The role focuses on MS-DRG/APR-DRG payment systems and claims experience across inpatient and outpatient settings. Candidates should be proactive, independent, and able to work in a fast-paced environment.

Salary ranges from $120k to $125k, with benefits. Visit EXL's careers page for more information.