[Hiring] Diagnosis-Related Group (DRG) Manager @EXL

Role Description

The DRG Manager leads the planning, coordination, and execution of DRG audit activities, ensuring teams meet client SLAs and operational goals. This role oversees inventory, aging, risks, and day-to-day performance, while collaborating cross-functionally to support program success.

The role directly manages a team of auditors responsible for MS-DRG and APR-DRG reviews, ensuring accurate coding and reimbursement outcomes. The ideal candidate demonstrates strong leadership and analytical skills, along with expertise in Coding Guidelines, Coding Clinic, and audit tools, and a solid understanding of CMS regulations and payer requirements.

• Salary Range: $100,000 – $120,000 (based on experience, skills, and qualifications)
• Location: 100% Remote (U.S.-based)
• Up to 10% annual travel (for team meetings and limited client onsite engagements)
• A brief coding/auditing assessment may be included as part of the interview process.

Responsibilities

• Support the execution and ongoing improvement of DRG audit programs, including readmissions and place of service reviews
• Partner with cross-functional teams (product, analytics, technology, operations) to support implementation of audit solutions
• Oversee day-to-day audit operations, ensuring alignment with SLAs, quality expectations, and productivity goals
• Manage inventory, workflow distribution, aging, and throughput to ensure timely completion of audits
• Provide direct supervision to auditors, including coaching, feedback, and performance management
• Ensure adherence to productivity, quality, and turnaround standards
• Monitor regulatory and payer guideline updates, ensuring audits remain compliant and current
• Support performance management processes, including one-on-ones, training, and development planning
• Identify operational gaps and contribute to process improvement initiatives
• Escalate and help resolve client or operational issues as needed
• Support reporting activities, including productivity, quality, and inventory metrics
• Assist with program implementations and operational initiatives

Qualifications

• CCS, RHIT, RHIA preferred
• 5–8 years of experience with MS-DRG and APR-DRG, including strong knowledge of ICD-10-CM/PCS and Official Coding Guidelines
• Prior experience leading teams or acting in a supervisory capacity
• Strong understanding of DRG reimbursement methodologies
• Knowledge of Medicare, Medicaid, and commercial payer guidelines
• Experience working in audit or payment integrity operations
• Strong analytical skills with ability to identify trends and support decision-making
• Effective communication and interpersonal skills
• Proficiency in Microsoft Office and audit/reporting systems

Key Skills & Attributes

• Ability to manage audit workflows and team performance to meet operational targets
• Strong understanding of quality, productivity, and audit accuracy standards
• Ability to analyze data and identify trends and improvement opportunities
• Effective collaboration across clinical, operational, and technical teams
• Ability to support process improvements and workflow enhancements
• Strong organizational and time management skills
• Ability to build relationships and maintain positive team and client interactions

Benefits

• A fast-paced, innovative environment with a team of industry-leading experts
• Hands-on experience with top-tier clients in the healthcare industry
• A strong culture of collaboration, support, and inclusivity
• Competitive benefits package, including healthcare, vision, dental, and 401(k) options