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Supervisor, DRG Reviews Specialist

1 month ago

Phoenix, Arizona, United States Triwest Healthcare Full time
Job Summary

TriWest Healthcare Alliance is seeking a highly skilled and experienced Supervisor to lead our Diagnosis-Related Group (DRG) validation process and coding staff. As a key member of our team, you will be responsible for ensuring contractual compliance and overseeing the retrospective review of medical claims for appropriate DRG or non-DR coding and processing.

Key Responsibilities
  • Supervise and manage a team of coding staff to ensure accurate and timely completion of DRG validation reviews.
  • Develop and implement policies and procedures to ensure compliance with contractual requirements.
  • Collaborate with internal stakeholders to ensure seamless integration of coding and validation processes.
  • Stay up-to-date with changes in coding regulations and practices, and implement new codes and guidelines as necessary.
  • Provide coaching and mentoring to staff on performance standards, employee issues, and concerns.
  • Interpret relevant sections of the TRICARE Operations Manual, TRICARE Policy Manual, and TRICARE Reimbursement Manual to perform functions.
Requirements
  • Bachelor's degree or equivalent combination of education and experience.
  • Current Certification as Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC).
  • 2+ years of clinical experience.
  • 2+ years of coding experience.
  • 2+ years of processing medical claims.
  • 2+ years of UM experience utilizing commercially developed UM criteria.
  • 2+ years of supervisory/management experience.
Preferred Qualifications
  • Managed Care experience.
  • Familiarity with TRICARE and military health care delivery system.
Working Conditions
  • Availability to work any shift.
  • Works remotely, with up to 10% travel.
  • Ability to meet mandatory contract compliance timelines.
  • Extensive computer work with prolonged sitting.