Manager, DRG Review (REMOTE)
Franklin, TN
Denials /
Full-Time /
Remote
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers’ Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years.
Position Summary
The Manager, DRG Review leads a team of DRG Reviewers while continuing to perform hands-on inpatient claim reviews to identify and validate missed reimbursement opportunities. This role oversees daily workflow, provides training and guidance on coding accuracy, and ensures departmental quality and productivity standards are met. Leveraging deep expertise in ICD-10 coding and DRG reimbursement methodology, the Manager partners closely with leadership to optimize hospital reimbursement, drive revenue opportunities, and support client success. This position requires a Certified Coding Specialist (CCS) credential and proven experience in DRG validation, as well as the ability to balance leadership responsibilities with ongoing case review work. This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.
Key Responsibilities
- Supervise and mentor a team of DRG Reviewers, providing guidance on coding best practices, case prioritization, and workflow management.
- Review inpatient claims imported into the DRG database to validate coding accuracy and reimbursement opportunities.
- Ensure department productivity and quality standards are achieved through monitoring, coaching, and performance evaluations.
- Collaborate with leadership to allocate resources, manage workloads, and set team priorities.
- Analyze weekly hospital billing files, identifying underpaid claims based on ICD-10 diagnosis and procedure codes.
- Provide ongoing education on ICD-10 updates, payer guidelines, and DRG reimbursement changes.
- Analyze reports to identify trends, revenue opportunities, and areas for process improvement.
- Conduct detailed medical record reviews post-bill to determine if submitted diagnosis and procedure codes are accurate and complete.
- Identify and correct errors such as under coded or misclassified diagnoses and procedures.
- Make reimbursement improvement recommendations and submit findings for client review and approval.
- Partner with internal stakeholders to ensure accurate reporting and timely delivery of client findings.
- Serve as an escalation point for complex coding or reimbursement issues.
- Stay informed on coding updates, payer guidelines, and DRG changes to support accurate recommendations.
- Identify new revenue opportunities related to all inpatient DRG related components.
- Other duties as required
Requirements & Qualifications
- Associate or bachelor’s degree in health information management or related field required. RHIT or RHIA credentialed individuals preferred.
- Certified Coding Specialist (CCS) certification required.
- 4-6 years’ experience in DRG validation, inpatient medical coding, or related coding review, with at least 1-2 years in a leadership or supervisory role.
- Strong understanding of ICD-10-CM/PCS coding guidelines, DRG reimbursement methodology, and hospital billing processes.
- Proven ability to lead, coach, and develop a high-performing team while balancing individual workload.
- Proficient in EMRs, DRG grouping software, billing databases, and MS Office applications.
- Strong analytical skills with a focus on financial impact, reimbursement accuracy, and process improvement.
- To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
Special Considerations and Prerequisites
- This role is primarily office-based or remote, depending on company policy, with extensive computer and document review work.
- Excellent communication skills, with the ability to interact effectively with clients and internal teams.
- Must be comfortable balancing team management with independent, detail-oriented review work.
- Analytical thinker with a focus on financial impact and reimbursement accuracy.
- Must be comfortable working independently in a detail-oriented, data-driven environment.
- Excellent communication and documentation skills to support client reporting and recommendations.
- High integrity and professionalism in handling PHI and confidential information.
- Strong collaboration and responsiveness to feedback from leadership and client partners.
- Ability to review and analyze large volumes of medical and billing data.
- Strong focus and attention to detail in identifying discrepancies and ensuring compliance.
- Ability to manage high volumes of case processing with accuracy and efficiency.
- Ability to meet deadlines and handle time-sensitive workloads in a high-volume environment.
- Proven written and verbal communication skills.
- Strong analytical and problem-solving skills.
- Ability to prioritize and manage multiple competing priorities and projects concurrently.
- Proven experience working with external clients; strong customer service skills and business acumen.
- Timely and regular attendance.
EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment.
EnableComp recruits, develops and retains the industry's top talent. As the employer of choice in the complex claims industry, EnableComp takes pride in our continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people. We believe that investing in our employees is the key to our success, and we are dedicated to providing them with the tools, resources, and support they need to thrive and grow their career here. At EnableComp, we are committed to living up to our core values each and every day, and we believe that this commitment is what sets us apart from other companies. If you are looking for a company that values its employees and is dedicated to helping them achieve their full potential, then EnableComp is the place for you.
Don’t just take our word for it! Hear what our people are saying:
“I love my job because everyone shares the same vision and is determined and dedicated. People care about you as a person and your professional growth. There is a genuine spirit of cooperation and shared goals all revolving around helping each other.” – Revenue Specialist
“I enjoy working for EnableComp because of the Core Values we believe in. EnableComp stands true to these values from empowering employees to ecstatic clients. This company is family oriented and flexible, along with understanding the balance of work, life, and fun.” – Supervisor, Operations
