CorVel
Ceris Drg Audit Program Director
The Drg Audit Program Director is a strategic and operational leader responsible for the development, implementation, and oversight of all Drg clinical validation and audit initiatives. This role ensures the integrity of healthcare payments by identifying and recovering improper payments, optimizing Drg assignments, and driving process improvements to enhance coding accuracy, documentation completeness, and compliance. The Director leads a team of clinical and coding auditors and collaborates cross-functionally with various departments to achieve organizational goals. Key responsibilities include: Strategic planning & vision Program management & oversight Team leadership & development Compliance & quality assurance Data analysis & reporting Cross-functional collaboration Education & training Qualifications: Bachelor's degree in Health Information Management (HIM), Nursing, Healthcare Administration, or a related field. Master's degree preferred. Certifications: One or more of the following AHIMA certifications are typically required: Registered Health Information Administrator (RHIA) Registered Health Information Technician (RHIT) Certified Coding Specialist (CCS) Certified Inpatient Coder (CIC) Other relevant certifications (e.g., Certified Clinical Documentation Specialist - CCDS) may be preferred. Minimum of 7-10 years of progressive experience in Drg coding, clinical validation, medical auditing, or payment integrity, with a strong focus on inpatient Drgs (MS-DRG, APR-DRG, AP-DRG). At least 3-5 years of leadership or management experience in a healthcare audit or payment integrity setting. Extensive experience with ICD-9/10-CM/PCS coding guidelines, Medicare and Commercial coding rules, regulations, and prospective payment systems. Proven experience in managing and developing audit programs. Experience with readmission reviews is a plus. Expert knowledge of clinical criteria documentation requirements and their impact on Drg assignments. Superior knowledge of healthcare coding, billing, and reimbursement principles. Strong analytical and problem-solving skills to identify trends, develop solutions, and implement action plans. Excellent written and verbal communication skills, with the ability to present complex information clearly and concisely to diverse audiences (clinical, technical, leadership). Strong leadership, interpersonal, and team-building skills. Proficiency in audit tools, electronic medical records (EMR) systems, abstracting systems (e.g., 3M, Epic), and Microsoft Office Suite (Word, Excel, PowerPoint). Ability to work efficiently and effectively with minimal supervision, manage multiple priorities, and meet deadlines. High standards of quality and attention to detail. Physical demands and work environment: Hybrid in office-based role in Fort Worth, TX, with remote work. May require occasional travel to client sites or conferences. Standard office environment with prolonged periods of sitting and computer use. Pay range: $121,571
$157,903 Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an equal opportunity employer, drug free workplace, and complies with ADA regulations as applicable.
The Drg Audit Program Director is a strategic and operational leader responsible for the development, implementation, and oversight of all Drg clinical validation and audit initiatives. This role ensures the integrity of healthcare payments by identifying and recovering improper payments, optimizing Drg assignments, and driving process improvements to enhance coding accuracy, documentation completeness, and compliance. The Director leads a team of clinical and coding auditors and collaborates cross-functionally with various departments to achieve organizational goals. Key responsibilities include: Strategic planning & vision Program management & oversight Team leadership & development Compliance & quality assurance Data analysis & reporting Cross-functional collaboration Education & training Qualifications: Bachelor's degree in Health Information Management (HIM), Nursing, Healthcare Administration, or a related field. Master's degree preferred. Certifications: One or more of the following AHIMA certifications are typically required: Registered Health Information Administrator (RHIA) Registered Health Information Technician (RHIT) Certified Coding Specialist (CCS) Certified Inpatient Coder (CIC) Other relevant certifications (e.g., Certified Clinical Documentation Specialist - CCDS) may be preferred. Minimum of 7-10 years of progressive experience in Drg coding, clinical validation, medical auditing, or payment integrity, with a strong focus on inpatient Drgs (MS-DRG, APR-DRG, AP-DRG). At least 3-5 years of leadership or management experience in a healthcare audit or payment integrity setting. Extensive experience with ICD-9/10-CM/PCS coding guidelines, Medicare and Commercial coding rules, regulations, and prospective payment systems. Proven experience in managing and developing audit programs. Experience with readmission reviews is a plus. Expert knowledge of clinical criteria documentation requirements and their impact on Drg assignments. Superior knowledge of healthcare coding, billing, and reimbursement principles. Strong analytical and problem-solving skills to identify trends, develop solutions, and implement action plans. Excellent written and verbal communication skills, with the ability to present complex information clearly and concisely to diverse audiences (clinical, technical, leadership). Strong leadership, interpersonal, and team-building skills. Proficiency in audit tools, electronic medical records (EMR) systems, abstracting systems (e.g., 3M, Epic), and Microsoft Office Suite (Word, Excel, PowerPoint). Ability to work efficiently and effectively with minimal supervision, manage multiple priorities, and meet deadlines. High standards of quality and attention to detail. Physical demands and work environment: Hybrid in office-based role in Fort Worth, TX, with remote work. May require occasional travel to client sites or conferences. Standard office environment with prolonged periods of sitting and computer use. Pay range: $121,571
$157,903 Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an equal opportunity employer, drug free workplace, and complies with ADA regulations as applicable.