Apixio is hiring a
DRG Manager
Apixio
π΅ $80k-$135k
πRemote - Worldwide
Please let Apixio know you found this job on JobsCollider. Thanks! π
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
- Bachelorβs 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
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Please let Apixio know you found this job on JobsCollider. Thanks! π