Manager, DRG Validation
2 days ago
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HybridFull-timeMid
Summary
Zelis is seeking a Manager, DRG Validation to join their team in St. Petersburg, FL. The role involves overseeing daily operations and team management of the DRG product, ensuring accurate and compliant coding based on industry standards.
About the Role
As the Manager, DRG Validation, you will oversee the DRG validation process, manage claim assignments, serve as a Subject Matter Expert, lead a team of coding professionals, monitor key performance indicators, implement quality assurance programs, collaborate with various teams, and identify new coding concepts for growth opportunities.
About You
Required:
- Registered Nurse licensure required
- Inpatient Coding Certification required (i.e., CCS, CIC, RHIA, RHIT)
- 5 - 7 years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims required
- Strong understanding of hospital coding and billing rules
- Outstanding verbal and written communication skills
Preferred:
- Supervisory experience preferred
- Solid understanding of audit techniques and identification of revenue opportunities
- Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs
- Clinical and critical thinking skills to evaluate appropriate coding
- Experience conducting root cause analysis and identifying solutions
Zelis
Zelis is modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts.
St. Petersburg, FL