DRG Quality Manager

EXL

. Support the execution and ongoing improvement of DRG quality review programs, including readmissions and place of service reviews .

Posted 9/17/2026full-timeRemote • United StatesMid-LevelSenior💰 $100,000 - $120,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in DRG quality review programs, including strong knowledge of ICD-10-CM/PCS and coding guidelines. Proven ability to lead teams, manage quality operations, and drive process improvements while ensuring compliance with regulatory standards.

Highest-signal resume keywords

Active Coding Credential (CCS, RHIT, RHIA, CPC)MS-DRG and APR-DRG ExperienceICD-10-CM/PCS KnowledgeHealthcare Quality Operations ExperienceProcess Improvement Methodologies (Lean, Six Sigma)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

DRG Reimbursement MethodologiesAudit and Reporting SystemsData AnalysisQuality Control ProcessesWorkflow Management

Soft Skills

Effective CommunicationInterpersonal SkillsCoaching and FeedbackPerformance Management

Tools & Technologies

Microsoft OfficeExcelDashboards

Certifications & Qualifications

CCSRHITRHIACPC

Industry Keywords

Medicare RegulationsMedicaid RegulationsCMS RegulationsCommercial Payer GuidelinesQuality Review Programs

About the role

Key responsibilities & impact

Support the execution and ongoing improvement of DRG quality review programs, including readmissions and place of service reviews
Partner with technology, operations, and training teams to implement audit quality solutions
Oversee day-to-day quality review operations in alignment with client SLAs, quality expectations, productivity goals, and internal standards
Manage quality review inventory, workflow distribution, QA aging, and productivity
Directly supervise DRG quality analysts and, as needed, analysts supporting other clinical or coding quality specialties
Provide coaching, feedback, performance management, one-on-ones, training, and development planning
Ensure adherence to productivity, quality, accuracy, and SLA standards
Monitor regulatory and payer guideline updates to keep reviews compliant and current
Identify quality, operational, and process gaps and drive improvement initiatives
Escalate and help resolve client, quality, auditor performance, and operational issues
Support reporting on productivity, quality, audit accuracy, QA inventory, and defect trends
Assist with program implementations by defining quality expectations, review criteria, and quality control processes
Ensure consistency and alignment across quality analysts, programs, Operations, Training, and global partners
Facilitate ongoing development, knowledge depth, and upskilling of quality analysts

Requirements

What you’ll need

Active coding credential required, such as CCS, RHIT, RHIA, or CPC
5–8 years of experience with MS-DRG and APR-DRG
Strong knowledge of ICD-10-CM/PCS and Official Coding Guidelines
Prior experience leading teams or acting in a supervisory capacity
Strong understanding of DRG reimbursement methodologies
Knowledge of Medicare, Medicaid, CMS regulations, and commercial payer guidelines
Experience in audit, payment integrity operations, healthcare quality operations, or coding quality review
Strong analytical skills with ability to identify trends and support decision-making
Effective communication and interpersonal skills
Proficiency in Microsoft Office, dashboards, Excel, and audit/reporting systems
Knowledge of process improvement methodologies, including Lean, Six Sigma, or equivalent, preferred
A brief coding/auditing assessment may be included as part of the interview process

Benefits

Comp & perks

Competitive benefits package, including healthcare, vision, dental, and 401(k) options
Fast-paced, innovative environment with a team of industry-leading experts
Hands-on experience with top-tier clients in the healthcare industry
Strong culture of collaboration, support, and inclusivity
Limited travel may be required for team meetings