Manager, DRG Coding & Validation (RN) - Remote

Overview

The Manager, Clinical DRG Coding & Validation is responsible for overseeing the DRG validation program, ensuring accurate coding and claims payment integrity within a remote work environment.

In Short

• Manage the development and implementation of the DRG validation program.
• Audit inpatient medical records for claims payment accuracy.
• Perform clinical reviews to evaluate coding and DRG assignment accuracy.
• Ensure timely settlement of claims in accordance with coding guidelines.
• Lead and train a team of medical claim review nurses.
• Provide ongoing training and feedback to team members.
• Ensure compliance with CMS guidelines and coding standards.
• Identify opportunities for process improvement in claims auditing.
• Maintain proficiency in proprietary auditing systems.
• Escalate claims issues as necessary to senior management.

Requirements

• Bachelor's Degree in Nursing or Health Related Field.
• 7+ years of Clinical Nursing experience.
• 5+ years in claims auditing or quality assurance.
• 3+ years of Utilization Review or Medical Claims Review experience.
• 3+ years of managerial experience.
• Strong knowledge of DRG, ICD-10, CPT, and HCPCS coding.
• Proficiency in Microsoft Office applications.
• Excellent communication skills.

Benefits

• Competitive benefits and compensation package.
• Remote work flexibility.
• Opportunities for professional development.
• Supportive work environment.