Remote DRG Manager

Summary

Join Apixio, a leading Connected Care platform, as the DRG Manager and contribute to minimizing reimbursement inaccuracies and high-quality patient care. This role requires expertise in healthcare payment methodologies and audit and review criteria. As a proactive and strategic thinker with strong leadership and analytical skills, you will drive the success of our clinical solutions and ensure optimal team performance.

Requirements

• Bachelor’s degree (health administration, business, nursing)
• Equivalent experience of 5+ years in healthcare billing and coding
• Equivalent experience of 2+ years in claims auditing and recovery auditing

Responsibilities

• Enhance and Review Clinical Solutions: Utilize expertise to assist in the enhancement and review of readmissions, place of service, and other clinical solutions
• Collaborative Development: Work with a multi-disciplinary team of programmers, operations staff, product leaders, and auditors to bring DRG process ideas from creation to implementation
• Regulatory Monitoring: Assess and adjust written rules by monitoring their effectiveness, keeping up with regulatory updates, and making necessary changes
• Team Leadership: Lead the DRG team by providing guidance, counsel, and development plans to ensure long-term retention and professional growth of DRG staff
• Claims Review Management: Oversee the entire process of clinical claims review, understanding various client configurations and workflows
• Operational Oversight: Manage scheduling, reporting to management, issue resolution, and execution of plans
• Work Coordination: Assign and prioritize work, set goals, and coordinate daily activities of the team. Provide regular updates and communication through one-on-one and team meetings
• Performance Monitoring: Monitor individual and team results to ensure timely completion of work in accordance with department standards and medical policy guidelines
• Analytical Problem-Solving: Demonstrate analytical skills to identify problems and trends, develop solutions, and implement action plans
• Policy and Process Development: Develop departmental policies, processes, and training standards
• Support and Evidence: Provide internal and external partners with evidence and references supporting industry standards, auditing guidelines, and review stances
• Performance Reporting: Provide reports on key performance indicators, including quality scores, workflows, savings, revenue projections, and inventory on a predetermined schedule
• Solution Development: Collaborate with a multi-disciplinary team to suggest solution development, including operations, product, data analytics, and technology
• Timeline Management: Set timelines and ensure communication on progress, tracking delivery, and escalating roadblocks or dependencies
• Program Deployment: Design and deploy effective programs/solutions to identify and correct claims with aberrant results, providing feedback to resolve root causes
• Research and Special Projects: Assist with research, special projects, and ad hoc claim reviews as needed

Preferred Qualifications

Preferred coding certification and nursing license

Benefits

• Competitive compensation
• Exceptional benefits, including medical, dental and vision, FSA
• 401k with company matching up to 4%
• Generous vacation policy
• Remote-first & hybrid work philosophies
• A hybrid work schedule (2 days in office & 3 days work from home)
• Modern open office in beautiful San Mateo, CA; Los Angeles, CA; San Diego, CA; Austin, TX and Dallas, TX
• Subsidized gym membership
• Catered, free lunches
• Parties, picnics, and wine-downs
• Free parking