DRG Manager (Healthcare)

TL;DR

DRG Manager (Healthcare): Development and management of clinical solutions, including MS and APR-DRG validation, with an accent on healthcare payment methodologies and audit criteria. Focus on leading the DRG team, optimizing claims review processes, and ensuring regulatory compliance.

Location: Remote (Must be based in the US)

Salary: $125,000–$140,000 USD

Company

hirify.global is a healthcare intelligence company providing an AI-powered platform to maximize financial outcomes and transparency for health plans.

What you will do

• Develop and enhance clinical solutions for readmissions, place of service, and other clinical validations.
• Collaborate with programmers, operations, and product leaders to move DRG process ideas from creation to implementation.
• Lead the DRG team by providing guidance, development plans, and professional growth support.
• Oversee the clinical claims review process, managing various client configurations and workflows.
• Monitor regulatory updates and adjust written rules to ensure ongoing effectiveness.
• Provide detailed reporting on KPIs, including quality scores, savings, and revenue projections.

Requirements

• Bachelor’s degree in health administration, business, or nursing.
• Must be based in the US.
• 5+ years of experience in healthcare billing and coding.
• 3+ years of experience in claims auditing and recovery auditing.
• Expertise in MS-DRG, APR-DRG, AP DRG, and outpatient payment systems (APCs, EAPGs).
• Familiarity with Milliman and InterQual guidelines.

Culture & Benefits

• Work from anywhere in the US (digital-first environment).
• Competitive salary, 401(k) with company match, and meaningful equity.
• Unlimited PTO.
• Comprehensive Medical, Dental, and Vision offerings.
• FSA/HSA and tuition reimbursement.
• Flexible and trusting work environment.