Director, Pre-Bill DRG Review – Quality Assurance, Training & Education
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Job Description
Director of Pre-Bill DRG Review at CorroHealth leading quality assurance, training, and education for coding staff. Ensuring compliance and accuracy in DRG validation processes.
Responsibilities:
- Lead the organization's internal pre-bill DRG validation program, ensuring coding accuracy, DRG integrity, and compliance
- Design, implement, and continuously improve the quality assurance framework for pre-bill coding review
- Build and lead training and education infrastructure for coding staff, CDI specialists, and auditors
- Partner with HIM leadership, CDI, Compliance, Revenue Cycle, and Physician Advisors to reduce DRG mismatches and denials
- Establish and maintain a QA framework for coding and DRG validation
- Set and monitor performance benchmarks and report trends to senior leadership
- Manage a team of DRG validators, quality auditors, and/or training specialists
Requirements:
- Bachelor's degree in Health Information Management, Nursing, Health Administration, or related field required
- Master's degree preferred
- Certification RHIA, RHIT, CCS, or CDIP required (one or more)
- CCDS or CCS-P a plus
- Active, unencumbered credential required; must be maintained throughout employment
- 7+ years of progressive experience in inpatient coding, DRG validation, clinical documentation integrity, or coding quality/compliance auditing
- 3+ years of leadership or management experience, including oversight of quality assurance and/or training functions
- Demonstrated expertise in MS-DRG and APR-DRG methodology, ICD-10-CM/PCS coding, and CMS regulatory requirements
- Experience designing and delivering adult education/training programs in a healthcare coding or clinical setting
- Prior experience with pre-bill review, second-level review, or denials/appeals management strongly preferred
Benefits:
- Competitive salary commensurate to related experience
- Quality of life with a remote predictable, full-time schedule
- Medical, Dental, Vision coverage + more
- 401K with company match
- Long-term disability insurance, and life insurance
- Ample parental leave
- Certification and Tuition Reimbursement
- Holidays and Flexible paid time off
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