California Licensed DRG Manager

Job Summary

A company is looking for a DRG Manager to oversee the development and management of clinical solutions related to healthcare payment methodologies.

Key Responsibilities

• Enhance and review clinical solutions including readmissions and place of service
• Lead the DRG team, providing guidance and development plans for staff
• Manage the clinical claims review process and oversee operational scheduling and reporting

Required Qualifications

• Bachelor's degree in health administration, business, or nursing
• 5+ years of experience in healthcare billing and coding
• 3+ years of experience in claims auditing and recovery auditing
• Proven knowledge of classification systems such as MSDRG and APR DRG
• Expertise in DRG validation and clinical criteria documentation requirements