The DRG Manager leads the planning, coordination, and execution of DRG audit activities, ensuring teams meet client SLAs and operational goals. This role oversees inventory, aging, risks, and day-to-day performance, while collaborating cross-functionally to support program success.
The role directly manages a team of auditors responsible for MS-DRG and APR-DRG reviews, ensuring accurate coding and reimbursement outcomes. The ideal candidate demonstrates strong leadership and analytical skills, along with expertise in Coding Guidelines, Coding Clinic, and audit tools, and a solid understanding of CMS regulations and payer requirements.
Salary Range: $100,000 – $120,000 (based on experience, skills, and qualifications)
Location: 100% Remote (U.S.-based)
Up to 10% annual travel (for team meetings and limited client onsite engagements.)
A brief coding/auditing assessment may be included as part of the interview process.
For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
Responsibilities- Support the execution and ongoing improvement of DRG audit programs, including readmissions and place of service reviews
- Partner with cross-functional teams (product, analytics, technology, operations) to support implementation of audit solutions
- Oversee day-to-day audit operations, ensuring alignment with SLAs, quality expectations, and productivity goals
- Manage inventory, workflow distribution, aging, and throughput to ensure timely completion of audits
- Provide direct supervision to auditors, including coaching, feedback, and performance management
- Ensure adherence to productivity, quality, and turnaround standards
- Monitor regulatory and payer guideline updates, ensuring audits remain compliant and current
- Support performance management processes, including one-on-ones, training, and development planning
- Identify operational gaps and contribute to process improvement initiatives
- Escalate and help resolve client or operational issues as needed
- Support reporting activities, including productivity, quality, and inventory metrics
- Assist with program implementations and operational initiatives
- CCS, RHIT, RHIA preferred
- 5–8 years of experience with MS-DRG and APR-DRG, including 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, and commercial payer guidelines
- Experience working in audit or payment integrity operations
- Strong analytical skills with ability to identify trends and support decision-making
- Effective communication and interpersonal skills
- Proficiency in Microsoft Office and audit/reporting systems
Key Skills & Attributes:
- Ability to manage audit workflows and team performance to meet operational targets
- Strong understanding of quality, productivity, and audit accuracy standards
- Ability to analyze data and identify trends and improvement opportunities
- Effective collaboration across clinical, operational, and technical teams
- Ability to support process improvements and workflow enhancements
- Strong organizational and time management skills
- Ability to build relationships and maintain positive team and client interactions
What We Offer:
✨ A fast-paced, innovative environment with a team of industry-leading experts
✨ Hands-on experience with top-tier clients in the healthcare industry
✨ A strong culture of collaboration, support, and inclusivity
✨ Competitive benefits package, including healthcare, vision, dental, and 401(k) options
The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.
About UsSkills Required
- 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 serving in a supervisory capacity
- Strong understanding of DRG reimbursement methodologies
- Knowledge of Medicare, Medicaid, and commercial payer guidelines
- Experience working in audit or payment integrity operations
- Strong analytical skills and ability to identify trends
- Effective communication and interpersonal skills
- Proficiency in Microsoft Office and audit/reporting systems
- CCS, RHIT, or RHIA certification
What We Do
Choosing a digital partner is about more than capabilities — it’s about collaboration and character. Unrealistic overhauls and off-the-shelf products ignore what matters most — your unique needs, culture, goals, and your legacy data and technology environments. At EXL, our collaboration is built on ongoing listening and learning to adapt our methodologies. We’re your business evolution partner—tailoring solutions that make the most of data to make better business decisions and drive more intelligence into your increasingly digital operations. Whether your goals are scaling the use of AI and digital, redesign operating models, or driving better and faster decisions, we’re here to partner with you to help you gain—and maintain—competitive advantage with efficient, sustainable models at scale. Our expertise in transformation, data science, and change management helps make your business more efficient and effective, improve customer relationships and enhance revenue growth. Instead of focusing on multi-year, resource- and time-intensive platform designs or migrations, we look deeper at your entire value chain to integrate strategies with impact. We use our specialization in analytics, digital interventions, and operations management—alongside deep industry expertise — to deliver solutions that help you outperform the competition. At EXL, it’s all about outcomes—your outcomes—and delivering success on your terms. Share your goals with us and together, we’ll optimize how you leverage data to drive your business forward. For more information, visit www.exlservice.com.
