Senior Manager - Diagnosis-Related Group (DRG) Data Analyst

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

The Senior Manager Diagnosis Related Group (DRG) SME will support the business team in evaluating trends on utilization of products / services based on historical data - such as care management trends, claim utilization, member attributes, to develop cost effective quality product / services. The ideal candidate retrieves, organizes and performs research/analysis on Medical Health Claim data primarily to identify root cause and is a proactive thinker, self-starter, who enjoys working in a fast-paced and challenging environment with the ability to work independently. Candidate should have a strong understanding of both inpatient MS-DRG/APR-DRG payment systems and have experience/knowledge in health care claims. Additional experience with Outpatient, HH, SNF, BH, IRF, Professional, DME, HCD claims is a plus. Previous claims payment and auditing experience would also be beneficial and recommended. Understanding of Medical claim terminology and insurance terminology. Experience with payer policy, claim system limitations, provider contracting terms are highly recommended. Experience with Pre-Pay and Post-Pay code edit/rules development is recommended/encouraged as well.

Salary Range for this role is: $120k - $125k

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits