[Remote] Manager, Payer Clinical Services (DRG)

Note: The job is a remote job and is open to candidates in USA. Trend Health Partners is a tech-enabled payment integrity company focused on improving access to healthcare. The Manager, Payer Clinical Services is responsible for overseeing the Clinical Coding Team, ensuring high-quality audits and operational support while fostering client relationships and staff development.

Responsibilities

• Oversee clinical/coding DRG audits, including MS-DRG, APR-DRG, readmission, and short-stay reviews, to ensure accuracy and compliance with internal policies and industry-standard guidelines
• Identify gaps and improvement opportunities and provide staff education to enhance audit quality and drive revenue performance
• Apply appropriate industry-standard coding guidelines, payer policies, and medical journal references relevant to audit review
• Maintain strong client relationships through accurate clinical and coding audits, continued understanding of client issues and needs, and compliance with payer policies, procedures, guidelines, and continuum-of-care requirements
• Identify client trends related to coding denials and report findings to the clinical team and clients, ensuring client issues are thoroughly acknowledged
• Oversee current staff and new-hire training related to technology, regulatory changes, and operational processes to support efficiency, client satisfaction, and high-quality results
• Participate in the development of education tools for staff and communicate expectations clearly to each team member
• Ensure clients receive detailed historical and current trend reports and verbally communicate findings to clients, coding teams, and nursing teams as appropriate
• Coach, develop, and mentor clinical staff to achieve quality performance by sharing knowledge and practicing servant leadership principles
• Continue developing personal management skills necessary to lead teams and handle unique operational challenges
• Organize training for new and existing team members to ensure each receives the information and tools needed to be successful
• Independently prepare, deliver, and assign client communications to support audit findings
• Maintain required certifications and continuing education requirements

Skills

• Administration, or a related field; equivalent work experience in a similar position may be considered
• Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Registered Nurse credential preferred
• Active coding certification, such as CCS, CPC, or CIC
• Extensive experience in DRG coding validation and/or auditing
• Experience training others
• Experience leading or managing a team
• DRG validation experience, including MS-DRG
• DRG validation experience, including APR-DRG
• Readmission audits
• Short-stay audits
• Policy development
• Quality assurance experience

Benefits

• Competitive salaries
• Highly valued health insurance
• A 401(k) plan with employer match
• Paid parental leave

Company Overview