Director, Pre-Bill DRG Review - Quality Assurance, Training & Education

Responsibilities

• Lead the evolution of the pre-bill DRG review program including workflows and case selection methodology
• Establish a quality assurance framework, including accuracy audits and root-cause analysis
• Set performance benchmarks for coding accuracy and provide trend reports to senior leadership
• Conduct second-level reviews of disputed DRG assignments and ensure resolution
• Align the pre-bill review program with coding guidelines and regulations
• Identify coding or documentation issues from QA findings and translate into process improvements
• Manage training and competency programs for coders and CDI staff involved in pre-bill DRG review

Qualifications

• Bachelor's degree in Health Information Management, Nursing, Health Administration, or related field
• Preferred Master's degree RHIA, RHIT, CCS, or CDIP certification required
• 7+ years of experience in inpatient coding or DRG validation
• 3+ years of leadership or management experience in QA or training functions