DRG QA and Trainer

Quality Assurance

• Review and audit the work of new and existing DRG Reviewers to ensure accuracy, compliance, and alignment with established coding and clinical validation guidelines.
• Provide constructive, detailed feedback to DRG Reviewers, highlighting areas for improvement and recognizing high-performance results.
• Collaborate with management to promote continuous improvement in audit accuracy, workflow efficiency, and reviewer performance.

Training Support

• Assist the educator by conducting supplemental training sessions for new hires on DRG methodologies, clinical validation, and proprietary tools.
• Provide ongoing training to existing staff, focusing on policy updates, skill development, and performance enhancement.
• Contribute to the development of training materials and resources as needed in collaboration with the educator.

Documentation & Reporting

• Maintain comprehensive documentation of audit findings, feedback sessions, and training activities.
• Generate reports on the quality assurance results and the effectiveness of training sessions for review by management.

Collaboration & Support

• Work closely with team leaders and the educator to ensure the training and QA processes align with the company’s standards and objectives.
• Serve as an expert resource for DRG Reviewers and other staff members, answering questions and offering guidance on complex cases or procedures.

Requirements

• Associate or bachelor’s degree in nursing, health information management, or a related field (relevant work experience may be considered in lieu of formal education).
• One or more of: RHIA, RHIT, CCDS, CDIP, CCS.
• 2+ years of experience in inpatient claims auditing, quality assurance, or clinical documentation integrity.
• 1+ year of experience in a training or mentoring capacity.
• Strong knowledge of DRG methodologies (MS & APR), ICD-10-CM/PCS coding, and UHDDS definitions.
• Expertise in clinical criteria documentation and healthcare coding rules and regulations.
• Ability to provide clear, actionable feedback; strong organizational and time management skills; excellent written and verbal communication; high standards for quality and attention to detail; ability to work independently and in teams.

Nice-to-Haves

• Experience working with multiple monitors and proven success in a remote working environment.
• Proficient in Windows office systems, including the full Microsoft Suite and Teams; advanced skills in Microsoft Office (Excel, PowerPoint, Word).
• Experience with various software applications and collaboration with development teams.
• Familiarity with multiple encoder/grouper applications.

Compensation

• Pay range: $100,000-$120,000 + Quarterly Bonus.
• Top Medical/Dental/Vision offerings, FSA/HSA, Tuition reimbursement, 401(k) with company match, additional health and wellness benefits and perks.
• Flexible and trusting environment.