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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in DRG quality review programs, including compliance with regulatory guidelines and effective team leadership. Proficient in audit quality solutions, productivity management, and operational improvement initiatives.
Highest-signal resume keywords
Active Coding Credential (CCS, RHIT, RHIA, CPC)MS-DRG and APR-DRG ExperienceICD-10-CM/PCS KnowledgeDRG Reimbursement Methodologies UnderstandingHealthcare Quality Operations Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Audit Quality ReviewQuality Control ProcessesData AnalysisProductivity ManagementRegulatory ComplianceQuality Improvement InitiativesPerformance ManagementWorkflow DistributionTrend IdentificationCoding Quality Review
Soft Skills
CoachingFeedbackCommunication SkillsAdaptabilityProject Management
Tools & Technologies
Microsoft OfficeExcelDashboardsAudit/Reporting Systems
Certifications & Qualifications
CCSRHITRHIACPC
Industry Keywords
MedicareMedicaidCMS RegulationsCommercial Payer GuidelinesLeanSix Sigma
About the role
Key responsibilities & impact- Support 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 against client SLAs, quality expectations, productivity goals, and internal standards
- Manage quality review inventory, workflow distribution, QA aging, and productivity
- Directly supervise DRG quality analysts through coaching, feedback, and performance management
- Ensure adherence to productivity, quality, accuracy, and SLA standards
- Monitor regulatory and payer guideline updates for compliance
- Support one-on-ones, training, and development planning
- 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 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 and ability to identify trends
- Proficiency in Microsoft Office, dashboards, Excel, and audit/reporting systems
- Knowledge of Lean, Six Sigma, or equivalent preferred
- Excellent verbal, written, and presentation communication skills
- Ability to manage multiple priorities and projects under pressure
- Ability to adapt to changing program, client, and operational needs
Benefits
Comp & perks- Healthcare insurance
- Vision insurance
- Dental insurance
- 401(k) options
- Work from home / 100% remote
- Limited travel for team meetings
- Hands-on experience with top-tier healthcare clients
- Collaborative, supportive, and inclusive culture
- Fast-paced, innovative environment