Senior Manager Operations at EXL
DRG SME- Senior Manager Operations
Job Location US-REMOTE | US-EXL Remote East Coast
Group SCIO Healthcare Analytics
Type Regular Full-Time
SCIO Health Analytics, an EXL Company, is looking for a DRG – Payment Integrity Ideation Analyst. This is a Home Office opportunity.
The successful candidate will manage a team of expert auditors, responsible for reviewing selected MS DRG and APR DRG selected cases for appropriate coding and reimbursement appropriate. The successful candidate will him/herself possess the coding skill set and sufficient experience to lead a team of expert coders by demonstrating mastery of the coding guidelines, coding clinics, and support tools. The successful candidate will also possess strong working knowledge of CMS rules guidelines and is abreast of regulatory changes.
- Actively participate in the case selection process to drive program performance and continuous improvement.
- Ensure audit staff is well trained, aligned, well able to achieve program goals and met performance requirements.
- Perform random and focused quality assurance audits, ensuring staff receives monthly feedback and performance updates.
- Ensure all facilities disputes are reviewed and effectively addressed.
- Provide daily support and direction of program activities.
- RHIA, RHIT, CCS, CPC with 5 years of inpatient coding experience
- Intermediate to advance Excel
- Must have 7-10 years of experience with MS DRG and APR DRGs with expert knowledge of ICD-9 official coding guidelines, as well as ICD-10-CM/PCS training. Certification is highly desirable.
- Must have experience with encoder tools (TrueCode, 3M, Webtrat, Pricers)
- Must possess strong leadership and organizational skills, 3-5 years of supervisory experience with the ability to develop work plans, action plans, standard operating procedures and build a strong teamwork environment of inclusiveness and support.
- Must possess excellent verbal/written communication skill
- Must possess experience with PowerPoint, Outlook, and Word
- Certified Health Data Analyst (CHDA) credential from AHIMA
- Degree in Health Informatics
- Degree in Data Analytics
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