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California Licensed DRG Manager
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
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
