DRG Validation Expert

7 days ago


Tampa, Florida, United States Apixio Full time
About the Role

The Clinical Solutions Manager is a key position at Apixio, responsible for the development and management of our clinical solutions, including MS and APR-DRG validation. This role requires expertise in healthcare payment methodologies and audit and review criteria to target key claims for review and recovery.

Key Responsibilities
  • Inventory and Team Management: Oversee the development and implementation of clinical solutions, ensuring they meet the needs of our clients and stakeholders.
  • Implementation Support: Provide guidance and support to clients and internal teams on the implementation of clinical solutions.
  • Client Support: Serve as a primary point of contact for clients, addressing their questions and concerns related to clinical solutions.
  • Research and Development: Conduct research and analysis to identify areas for improvement in clinical solutions and develop new solutions to meet emerging needs.
  • Management and Leadership: Lead a team of clinical solutions specialists, providing guidance, coaching, and development opportunities to ensure their success.
Requirements
  • Education: Bachelor's degree in a relevant field, such as health administration, business, or nursing.
  • Experience: 5+ years of experience in healthcare billing and coding, with a focus on claims auditing and recovery auditing.
  • Certifications: Preferred coding certification and nursing license.
What We Offer
  • Meaningful Work: Contribute to the development of innovative clinical solutions that improve healthcare outcomes and reduce costs.
  • Competitive Compensation: Receive a competitive salary and benefits package, including medical, dental, and vision insurance, FSA, and 401(k) with company matching.
  • Exceptional Benefits: Enjoy a generous vacation policy, remote-first work philosophy, and a hybrid work schedule.


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