Looking for the latest performance & process improvement careers in the healthcare industry? Click here.

Search for Jobs

1 Result
Versalus Health
Remote/from home, NA, United States
19 days ago
Versalus Health
Remote/from Home, United States
19 days ago

Description

Manager DRG Quality Assurance

Office Location: Remote opportunities (within the United States) 

Commitment: Full-Time

About Versalus Health

Versalus Health is an innovative, rapidly growing organization that provides hospitals with comprehensive solutions focused on the intersection of utilization management, revenue cycle, and compliance. Versalus Health has expanded its product offering to include DRG Revenue Integrity services. By leveraging advanced analytics and DRG auditing and clinical expertise, Versalus Health provides programmatic solutions for DRG compliance and revenue integrity. Versalus offers outstanding growth opportunities, a competitive salary and benefits package including bonuses based on individual and company performance, and reimbursement for continuing education and association dues. Versalus has a vibrant culture that strives to promote a positive work/life balance. Join our team and positively change healthcare!

Job Description:

The Manager of DRG Quality Assurance (QA) will be responsible for helping Versalus Health achieve its quality assurance and training objectives by recruiting, training, and managing the quality assurance staff. The Manager will utilize coding and clinical expertise to ensure all DRG Revenue Integrity services are compliant with official coding guidelines and supported by clinical documentation in the health record. The manager will conduct QA reviews as needed to meet daily production requirements.

Job Responsibilities: 

  • Responsible for taking the leadership role in changing/maintaining the focus on quality at the company. Support quality efforts throughout the organization.
  • Manages an effective corrective action and preventive actions (CAPA) process, including but not limited to the tracking, trend analysis, root cause analysis, and implementation of process improvement measures and effectiveness checks.
  • Leads audit readiness activities including but not limited to conducting routine/periodic quality assurance assessments to measure and ensure adherence of processes and procedures by internal personnel and external vendors.
  • Designs and manages the completion of internal audits and creation of Performance Improvement Plans (PIP). Assigns roles and responsibilities for each audit and validates the accuracy of final results.
  • Coordinates the workflow of the Quality Assurance staff to ensure the efficient and timely processing of materials and information.
  • Provides advice, counsel, and training to Quality Assurance staff.
  • Designs and runs reports for managing quality assurance services.
  • Reviews generated data to ensure the suitability of the Quality System and makes recommendations to improve quality metrics.
  • Educates personnel in the quality philosophy and practices to include improvement strategies.
  • Meets or exceeds standards for both quality and productivity set by the organization.
  • Other responsibilities as assigned. Duties may be subject to change at any time at the discretion of management, formally or informally, verbally or in writing.


Requirements

Required Education/ Experience:

  • RHIA/RHIT with CCS required. CDIP or CCDS is highly preferred and may be required after one year of employment. (Assistance is available for preparation.)
  • Certifications and/or professional license must be maintained as a condition of employment.
  • A minimum 5 years of management experience with demonstrated total quality management (TQM), communication, interpersonal, and leadership skills.
  • Experience in any of the following roles:
    • Inpatient coding quality assurance
    • DRG validation
    • DRG appeal
    • Clinical Documentation Integrity (CDI) as a Clinical Documentation Specialist (CDS), Educator, or Manager

Knowledge, Skills and Abilities: 

  • Clinical Validation Skills. Demonstrate the ability to identify, apply, and validate the use of current industry standard clinical indicators, risk factors and treatment protocols used in clinical validation of payment impacting code assignment. Solid command of anatomy, physiology, pathology, laboratory, imaging, pharmacology, disease assessment, management and treatment is required.
  • Critical Thinking. Actively and skillfully conceptualizes, applies, analyzes, synthesizes, and evaluates information gathered from, or generated by observation, experience, reflection, reasoning, or communication as a guide to validate audit results and correct as necessary.
  • Adaptability. Maintains effectiveness when experiencing changes in work tasks or the work environment; adapts to change in environment and/or circumstances with a positive outlook and adjusts effectively to work within new work structures, processes, requirements, or cultures.
  • Initiative. Proactive and self-directed. Shows initiative and responsibility in taking the necessary steps towards problem resolution. Is self-sufficient and does not need to rely on others to complete a job.
  • Vivacity. Consistently maintains high levels of activity or productivity sustained over long working hours when necessary; operates with vigor, effectiveness, and determination.
  • Performance. Meets or exceeds both production and quality expectations while performing complex medical record audits. Able to execute under pressure of time constraints and while managing multiple responsibilities. Proactively prioritizes initiatives, effectively manages resources and can multi-task. Actively manages their work assignments and seeks additional tasks when appropriate. 
  • Communication Skills. Communicates clearly, proactively, and concisely with all key stakeholders. Excellent written and verbal communication skills. Writes clear, compelling, accurate, and concise justifications in support of findings and successfully crafts appeal letters with precise logic.
  • Curious. Actively seek out new ideas, possibilities, and answers to the tough questions. Committed to life-long learning.
  • Detailed Oriented. Pays meticulous attention to detail, identifies aberrant code assignment, mines medical records for all relevant and supporting evidence, and conscientiously follows all steps in the audit.
  • PC Skills. Demonstrates proficiency in Microsoft Office, and Teams, Skype, WebEx, VPN access, navigating a variety of EHRs, and ability to problem solve Internet connectivity issues.

Benefits

  • Enjoy work-life balance with a predictable schedule
  • Compensation includes salary plus bonus opportunities
  • Medical, Dental, Vision coverage, 401K
  • Holidays, paid time off, short term and long-term disability insurance, and life insurance
  • Reimbursement for continuing education and association dues

Physical Requirements:

May be expected to sit at a desk for long hours. Must have a private and secure space to work, including a secure Internet connection. Repetitive movement of hands and fingers – typing and/or writing. Occasional standing, walking, stooping, kneeling or crouching. Ability to reach with hands and arms, talk, and hear. Exert up to 20 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.

Versalus Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. 

www.facebook.com/VersalusHealth/

Job Information

  • Job ID: 58470324
  • Location:
    Remote/from Home, United States
  • Position Title: Manager of DRG Quality Assurance
  • Company Name: Versalus Health
  • Industry: Consultant/Vendor
  • Job Function: Auditing
  • Job Type: Full-Time
  • Min Education: Associate
  • Min Experience: 5-7
  • Required Travel: None
  • Salary: $100,000.00 - $120,000.00 (Yearly Salary)

By leveraging advanced analytics and DRG auditing and clinical expertise, Versalus Health provides programmatic solutions for DRG compliance and revenue integrity.

View Full Profile

Jobs You May Like
Filters
Job Function
Industry
Job Type
State