DRG Quality Manager

The Drg Quality Manager position directly leads a team of DRG quality analysts who review auditor-completed MS-DRG and APR-DRG work to validate coding accuracy and ensure compliant reimbursement outcomes. The manager may oversee additional quality specialties within clinical or coding audit programs, providing guidance on audit processes and quality standards. Key responsibilities include reviewing audit documentation for precision, ensuring adherence to Coding Guidelines and Coding Clinic, monitoring compliance with CMS and payer requirements, and maintaining rigorous quality governance across reimbursement cycles. The ideal candidate possesses proven leadership ability, strong analytical acumen, and extensive experience with audit tools, DRG methodologies, and healthcare quality frameworks. This role demands deep expertise in U.S. Medicare and private payer coding regulations, reimbursement structures, and regulatory expectations in medical coding and audit environments. As a fully remote position open to U.S.-based professionals, the candidate will collaborate with remote teams and contribute to continuous improvement in coding integrity and financial compliance. The position requires a detail-oriented professional who understands the intersection of clinical documentation, coding accuracy, and healthcare reimbursement systems. Interested candidates must be prepared for a brief coding and auditing assessment as part of the interview process, reflecting the role’s technical rigor. To learn more about leadership opportunities and benefits, please visit the official career page. This is a full-time, exempt position with compensation ranging from $100,000 to $120,000, commensurate with experience and qualifications. The employer emphasizes professional growth, equity in performance, and a culture of operational excellence in health data governance.

Source: Himalayas