Manager, Payer Clinical Services (DRG)

Position Responsibilities:

• Oversee clinical/coding DRG audits including MS-DRG, APR-DRG, readmission, and short-stay reviews to ensure accuracy and compliance.
• Identify gaps and improvement opportunities and provide staff education to enhance audit quality and revenue performance.
• Apply appropriate industry-standard coding guidelines, payer policies, and medical journal references relevant to audit review.

Client Management:

• Maintain strong client relationships through accurate clinical and coding audits and understanding of client issues and needs.
• Identify client trends related to coding denials and report findings to the clinical team and clients.
• Ensure clients receive detailed historical and current trend reports and verbally communicate findings as appropriate.

Team Leadership and Development:

• Oversee staff and new-hire training on technology, regulatory changes, and operational processes.
• Coach, develop, and mentor clinical staff to achieve quality performance by sharing knowledge and practicing servant leadership.
• Organize training for new and existing team members to ensure each receives the tools needed to be successful.