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3 jobs similar to DRG (Diagnosis-Related Group) Business Solutions Lead

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  • Oversee clinical/coding DRG audits to ensure accuracy and compliance with internal policies and industry standards.
  • Maintain strong client relationships through accurate audits, understanding client needs, and reporting denial trends.
  • Coach, develop, and mentor clinical staff to achieve quality performance using servant leadership principles.

Trend Health Partners is a tech-enabled payment integrity company that facilitates collaboration between payers and providers to reduce waste and improve access to healthcare. The company offers a dynamic, innovative environment with a competitive compensation package including health insurance, 401(k) with match, and paid parental leave.

$85,000–$100,000/yr
US Unlimited PTO 14w maternity 14w paternity

  • Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG assignment and reimbursement.
  • Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications.
  • Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.

Cohere Health provides an AI-powered clinical intelligence platform that streamlines access to quality care by improving payer-provider collaboration and cost containment. The company works with over 660,000 providers, handles over 12 million prior authorization requests annually, and has been named to the Inc. 5000 list and a Top 5 LinkedIn Startup for 2023 and 2024.

$70,143–$107,253/yr
US

  • Perform detailed medical record reviews to validate DRG assignments and ensure billing accuracy.
  • Conduct clinical and coding audits to identify discrepancies and support cost containment.
  • Collaborate with quality teams and medical professionals to ensure compliance with payer regulations.

The company partners with healthcare organizations to ensure accuracy in medical coding and reimbursement. They offer a fully remote, supportive environment with comprehensive benefits and professional growth opportunities.