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CategoryHealthcare
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No of Jobs1
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Apply Before09/27/2025
Description
Manager, DRG Coding & Validation (RN) Remote
Lensa - Sioux City, IA
Job Title: Manager, DRG Coding & Validation (RN) Remote
Position: Lead oversight of DRG coding and validation processes
Job Type: Full Time
Pay: $77,969 - $171,058 / ANNUAL
Shift: Monday - Friday: 7:00 AM - 5:00 PM EST
Work Type: Remote
Location
Address:
City: Sioux City
State: IA
ZIP Code:
Job Responsibilities
- Develop and implement the DRG validation program.
- Audit inpatient medical records to ensure payment integrity.
- Perform clinical reviews of medical records for coding and DRG accuracy.
- Ensure timely settlement of claims in accordance with quality reviews of ICD-10-CM and/or CPT codes.
- Manage medical claim review team nurses and meet operational goals.
- Provide monthly feedback and develop work plans for team members.
- Conduct ongoing training for employees and delegate to team leads.
- Identify and escalate claims to Medical Directors and relevant teams.
- Ensure adherence to coding guidelines established within the Health Information Management Department.
Required Skills
Core Skills
- Extensive knowledge of MS-DRG, AP-DRG, and APR-DRG payment systems.
- Proficiency in ICD-9/10CM, CPT, HCPCS coding.
- Strong management and leadership capabilities.
- Excellent written and verbal communication skills.
Preferred Skills
- Experience with coding training and education.
- Proficiency in Word, Access, Excel, and auditing systems.
Requirements
Experience: 7+ years Clinical Nursing, 5+ years in claims auditing, 3+ years in Utilization Review and/or Medical Claims Review, 3+ years managerial experience.
Education: Bachelor's Degree in Nursing or Health Related Field.
License & Certification:
- Active, unrestricted State Registered Nursing (RN) license.
- Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC) certification.
Schedule:
COVID-19 Requirements: Not Specified
Benefits
- Competitive benefits and compensation package.
Supplemental Pay
- Not specified
Special Notes
- Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Facility Details
Name: Lensa
Description: Not Specified
Specialties:
- Not specified
Mission: Not Specified
Job Info
Discipline:
Department:
Status:
Sourcing
Duration:
Experience:
Career Level:
No of Jobs:
1
Apply Before:
09/27/2025
Posted:
06/27/2025
