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Director of Pre-Bill DRG ReviewVirtualVocations • Jersey City, New Jersey, United States
Director of Pre-Bill DRG Review

Director of Pre-Bill DRG Review

VirtualVocations • Jersey City, New Jersey, United States
2 days ago
Job type
  • Full-time
Job description
Leading the internal pre-bill DRG validation program, the full-time Director of Pre-Bill DRG Review will ensure coding accuracy and compliance prior to claim submission while designing and implementing a quality assurance framework and a training infrastructure for coding staff, all in a remote work environment. Key Responsibilities Own and evolve the pre-bill DRG review program, ensuring alignment with official coding guidelines and performance benchmarks Design and implement a structured training program for coders and auditors, developing ongoing education modules based on QA findings Collaborate with cross-functional teams to minimize billing delays and resolve clinical documentation ambiguities affecting DRG assignments Required Qualifications Bachelor's degree in Health Information Management, Nursing, Health Administration, or related field required; Master's degree preferred RHIA, RHIT, CCS, or CDIP certification required; CCDS or CCS-P is a plus 7+ years of experience in inpatient coding, DRG validation, or coding quality auditing, with 3+ years in a leadership role Expertise in MS-DRG and APR-DRG methodology, ICD-10-CM/PCS coding, and CMS regulations Experience designing and delivering adult education/training programs in a healthcare setting
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Director of Pre-Bill DRG Review • Jersey City, New Jersey, United States

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