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Manager, DRG Validation

Manager, DRG Validation

ZelisPlano, TX, US
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The Manager, DRG Validation of the Expert Claims Review (ECR) department is responsible for daily operations and team management of the DRG product. The Manager, DRG Validation will be primarily res...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
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Automation Engineer

Automation Engineer

SamprasoftPlano, TX, US
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Top skills : Java / JavaScript, Selenium, Automation, Cypress, Rest assured.serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Software Engineer

Software Engineer

Toyota Tsusho SystemsPlano, Texas, United States
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Design, develop, and deploy scalable cloud-based software solutions.Write clean, efficient, and maintainable code in programming languages such as Python, Java, C#, or JavaScript.Implement microser...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
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Splunk Engineer

Splunk Engineer

Perfict GlobalPlano, TX, US
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Perfict Global is a leading IT consulting services provider focused on providing innovative and successful business workforce solutions to Fortune 500 companies. Our trained and experienced professi...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
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Network Engineer

Network Engineer

Altice USAPlano, TX, US
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Location : Amarillo, TX, US, 79109 Plano, TX, US, 75024 Abilene, TX, US, 79605 San Angelo, TX, US, 76901.Are you looking to optimize your life? Start your exciting path to a rewarding career today!....serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
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Manager, DRG Validation

Manager, DRG Validation

Zelis Healthcare, LLCPlano, TX, United States
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Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers.We serve more than 750 payers, including the top five national health plans, regional hea...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Fellow, DCGPU Systems Design Validation

Fellow, DCGPU Systems Design Validation

AMDTX, US
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WHAT YOU DO AT AMD CHANGES EVERYTHING.We care deeply about transforming lives with AMD technology to enrich our industry, our communities, and the world. Our mission is to build great products that ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
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Network Engineer

Network Engineer

Zhone Technologies, Inc.Plano, TX, US
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The Network Test Engineer is responsible for verifying new releases of broadband network products, including OLTs, ONTs, and EMS, covering both hardware and software, prior to deployment to field s...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
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Data Engineer

Data Engineer

Argyle InfotechPlano, TX, US
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Work Location : Plano, TX or Atlanta, GA.Candidate's Experience : 5 Years of Experience.serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
DevOps Engineer

DevOps Engineer

AscenttPlano, Texas, United States
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Job Description (Summary of Responsibilities) : .Cloud Infrastructure Management : Design, implement, and manage cloud-based infrastructure on AWS and Azure, ensuring optimal scalability, performance,...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
DevOps Engineer

DevOps Engineer

PROLIM CorporationPlano, TX, United States
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PROLIM Global Corporation (www.Reporting Analyst location Plano, TX, United States for one of our Top clients.DevOps Engineer Plano, Texas (Onsite) Description Who we’re looking for We’re looki...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
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Aerospace Engineer

Aerospace Engineer

TradeJobsWorkforce75248 Dallas, TX, US
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Aerospace Engineer Job Duties : Contributes to the design, manufacturing, and testing of aircraft and a...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
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System Engineer

System Engineer

TradeJobsWorkForce75252 Dallas, TX, US
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System Engineer Job Duties : Manages and monitors all installed systems and infrastructure for ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
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Addressing Validation PM

Addressing Validation PM

Tech DigitalPlano, TX, US
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Prior experience in Telcom / Construction / design.Experience in Workfront / Sitetracker a plus.Program creation experience, Microsoft Excel experience required. Three plus years of experience in the tele...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
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Senior Analyst Model Validation

Senior Analyst Model Validation

VirtualVocationsPlano, Texas, United States
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A company is looking for a Senior Analyst, Model Validation.Key Responsibilities Validate the performance and controls of quantitative models Identify risks and provide recommendations to mitiga...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
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DevOps Engineer

DevOps Engineer

OctopartFrisco, TX, US
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Frisco, Texas, United States; Parsippany, New Jersey, United States.Altium is transforming the way electronics are designed and built. From startups to world's technology giants, our digital platfor...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
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Data Engineer

Data Engineer

StaffingPlano, TX, US
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Role : Data Engineer Location : Plano, TX.Job Summary : We seek a skilled Data Engineer proficient in Java and Python to design, develop, and optimize data pipelines and systems.The ideal candidate wi...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
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Telematics Validation Engineer

Telematics Validation Engineer

BTI SolutionsPlano, TX, US
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Telematics Validation Engineer.Everyone on our team has earned a CPC (Certified Personnel Consultant) or CTS (Certified Temporary Staffing Specialist) accreditation from the National Association of...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
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AI Engineer - Junior / Software Engineer

AI Engineer - Junior / Software Engineer

SynergisticITPlano, TX, US
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Job Opportunity At Synergisticit.Synergisticit is aware that the job market is challenging because of tech layoffs due to which the job market is flooded with hundreds and thousands of laid off job...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Data Engineer

Data Engineer

Spearhead TechnologyPlano, Texas, United States
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Spearhead Technology — where every challenge is an.As a full-lifecycle IT company, we transcend mere delivery; we.Be it planning, analysis, design,. Spearhead Technology, quality isn't a mere.We rec...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Manager, DRG Validation

Manager, DRG Validation

ZelisPlano, TX, US
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Position Overview

The Manager, DRG Validation of the Expert Claims Review (ECR) department is responsible for daily operations and team management of the DRG product. The Manager, DRG Validation will be primarily responsible for the oversight of DRG validation reviews to ensure accurate and compliant coding based on industry standard inpatient coding guidelines and rules, evidence based clinical criteria, and policy exclusions. Focus will be on analyzing and executing on current business and new client implementations, establishing, and monitoring team performance metrics and ensuring client needs are met.

What you'll do :

Oversee the DRG validation process including management of claim assignment and queues, adherence to client turnaround time and department procedures

Serve as the Subject Matter Expert on DRG validation to team members and other departments within the organization

Lead and manage a team of coding professionals by providing guidance, training, and support to encourage a positive and collaborative team culture

Monitor key performance indicators to track team productivity and accuracy, client and concept trends and implement improvement strategies

Implement and conduct quality assurance program to ensure accurate results to our clients

Collaborate with Product, IT, Implementation and Sales teams to drive growth initiatives and outcomes

Assist in dispute process and defense of denials as necessary

Must remain current in all national coding guidelines including Official Coding Guidelines, AHA Coding Clinic and AMA CPT Assistant

Participate in client facing meetings as necessary

Identify new DRG coding concepts to drive growth opportunities.

Recommend efficiencies and process improvements to improve departmental procedures

Maintain awareness of and ensure adherence to Zelis standards regarding privacy

What you'll bring to Zelis :

Registered Nurse licensure required

Inpatient Coding Certification required (i.e., CCS, CIC, RHIA, RHIT)

5 - 7 years reviewing and / or auditing ICD-10 CM, MS-DRG and APR-DRG claims required

Supervisory experience preferred

Solid understanding of audit techniques and identification of revenue opportunities

Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs

Strong understanding of hospital coding and billing rules

Clinical and critical thinking skills to evaluate appropriate coding

Experience conducting root cause analysis and identifying solutions

Strong organization skills with attention to detail

Outstanding verbal and written communication skills

Location and Workplace Flexibility

We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.