- Hingham, Massachusetts, United States
- Full-time · Manager
- $117K–$143K per year
- 5+ years
Lead a team of DRG validation auditors to perform pre‑payment and post‑payment clinical validation and DRG reviews, ensuring payment integrity and revenue recovery.
Compensation
Salary Range: $117,355.98 - $143,440.00
Responsibilities
- Direct, manage, and mentor a team of six DRG validation auditors performing pre‑pay and post‑pay clinical validation and DRG reviews.
- Verify the accuracy of inpatient claims reimbursement, clinical significance, medical necessity, coding, and billing in accordance with plan agreements and coding guidelines.
- Foster a culture of accountability, operational excellence, and continuous development.
- Oversee pre‑payment and post‑payment DRG validations and clinical audits, applying clinical, regulatory, and contractual expertise to identify overpayments and underpayments.
- Utilize grouper software with advanced proficiency, and oversee internal audit inventory, platforms, and automated editing workflows.
Requirements
- Bachelor’s Degree (BS/BA) required
- Clinical degree (e.g., BSN/RN) strongly preferred