A New York City health services network is currently seeking an experienced professional to join their staff as their new Senior Diagnosis Related Group & Clinical Validation Manager. In this role, the Senior Diagnosis Related Group & Clinical Validation Manager will be responsible for managing DRG and Clinical Validation by monitoring, enhancing, and building vendor and internal processes.

• Manage vendor performance of CV and DRG through analyzing metrics related to process and outcomes, monitoring trends and conducting audits
• Oversee monitoring of vendor performance against contractual obligations to ensure overall effectiveness of vendor provided services
• Lead expansion of Clinical and DRG programs by researching, analyzing data and identifying improvement opportunities
• Identify opportunities outside of the vendor process where additional recoveries may be available
• Integrate medical chart coding expertise and clinical guidelines to build upon existing processes and develop new initiatives
• Researches industry trends and regulatory updates to ensure and maintain competitive practices while remaining compliant with all applicable regulations
• Perform other duties, as needed

• 1+ year of DRG validation (Clinical or Coding Validation) experience
• Associate's Degree in Nursing and/or in Health Information Management (RHIA or RHIT)
• Certified Coding Certificate required (DRG)
• Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS/CIC)
• Thorough understanding of APR-DRG, MS-DRG, ICD-10, clinical criteria, HCPCS and clinical review judgement
• Solid understanding of health plan payment methodologies and reimbursement for different types of services
• Solid understanding of coding rules, regulations, and prospective payment rules
• Microsoft Office Suite proficient
• Solid analytical, budgeting, and forecasting
• Great interpersonal skills
• Excellent communication skills (written and verbal)
• Strong attention to detail
• Highly organized

• Bachelor's Degree in Nursing