Senior Manager, APR-DRG Concept Development

ExlService Holdings, Inc.; United States; On-site; USD 100,000 - 125,000; Full time

Job summary

EXL Talent Acquisition Team seeks an APR DRG Concept Development Analyst to collaborate with Payment Integrity Audit program leaders, DRG audit professionals and Data & Analytic teammates to research, develop and implement inpatient DRG audit selection criteria.

The successful candidate is quality focused with strong analytical skills and will demonstrate mastery-level ICD-10-CM and ICD-10-PCS coding, plus extensive knowledge of ICD-10 Official Coding Guidelines, AHA Coding Clinic guidelines,

Qualifications

• Background in payment integrity audits.
• Mastery-level ICD-10-CM and ICD-10-PCS coding skills.
• Deep knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies.

Responsibilities

• Develop inpatient DRG audit selection criteria.
• Analyze performance metrics to ensure alignment with team goals.
• Collaborate with Payment Integrity Audit leaders, DRG auditors, and Data & Analytics teams.

Skills

ICD-10-CM coding

ICD-10-PCS coding

AHA Coding Clinic guidelines

Data analytics

Job description

As an APR DRG Concept Development Analyst, you will collaborate with Payment Integrity Audit program leaders, DRG audit professionals and Data & Analytic team members to research,develop and implement inpatient DRG audit selection criteria. This role involves analyzing performance metrics and results to ensure alignment with our team goals.

The successful candidate will be quality focused, possess strong analytical skills and have a background in payment integrity audits.The successful candidate will demonstrate mastery-level coding skills in ICD-10-CM and PCS, along with extensive knowledge and expertise in the application of ICD-10 Official Coding Guidelines and AHA Coding Clinic guidelines. They will possess an advanced understanding of MS DRG and APR-DRG reimbursement methodologies and remain current with relevant regulatory changes.

Salary Range for this role is: $100k - $125k

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