{"id":3194562,"url":"https://alion.io/job/exl-senior-manager-apr-drg-concept-development-analyst","title":"Senior Manager - APR DRG Concept Development Analyst","company":{"id":38016,"name":"EXL","domain":"exlservice.com","url":"https://alion.io/company/exl","size_band":"5000+","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Oracle","truth_index":{"grade":"B","score":80,"open_postings":261,"ghost_share":0,"stale_share":1,"repost_share":0,"time_to_fill_p50_days":15,"computed_at":"2026-10-27T05:46:45Z"}},"role":"Analytics","role_family":"Analytics","seniority":"senior","employment_type":null,"work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["United States"],"countries":["US"],"hiring_countries":[],"hiring_countries_total":0,"salary":{"min":100000,"max":125000,"currency":"USD","period":"year","gross":null,"usd_annual":125000},"salary_estimate":null,"experience_years_min":10,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Microsoft Excel","optional":false}],"status":"live","first_seen_at":"2026-10-19T16:33:03Z","employer_posted_date":"2026-10-19","last_verified_at":"2026-10-27T09:55:16Z","board_verified":true,"closed_at":null,"days_open":7,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":7},"description":"As an APR DRG Concept Development Analyst, you will collaborate with Payment Integrity Audit program leaders, DRG audit professionals and Data & Analytic team members to research, develop and implement inpatient DRG audit selection criteria. This role involves analyzing performance metrics and results to ensure alignment with our team goals.\nThe successful candidate will be quality focused, possess strong analytical skills and have a background in payment integrity audits. The successful candidate will demonstrate mastery-level coding skills in ICD-10-CM and PCS, along with extensive knowledge and expertise in the application of ICD-10 Official Coding Guidelines and AHA Coding Clinic guidelines. They will possess an advanced understanding of MS DRG and APR-DRG reimbursement methodologies and remain current with relevant regulatory changes.\nSalary Range for this role is: $100k - $125k\nA brief coding/auditing assessment may be included as part of the interview process.\nFor more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits\n Subject matter expert for research, analysis and generation of new concepts and selection rules to identify overpayment opportunities in APR-DRG validation\nCollaborates with internal stakeholders including the audit and analytic teams to review concepts pre-and post- implementation to monitor concept performance and identify performance issues\nEffectively utilizes internal selection tools to build queries and concepts and test concept effectiveness\nDeliver results and insights to senior leaders\nAdjusts selection criteria based on specific client requirements\nResponsible for monthly claim screening and selection\nVerifies the selections output to ensure selection rules are functioning as intended\nReviews appeals/disputes to identify areas for improvement.\nCreates education and training documents and conduct handoff meetings with the Audit teams to ensure understanding of new audit concepts\nEnsures the clinical team is calibrated with client policies and internal concepts.\nUtilizes Audit Outcome trend reports to monitor and fine tune existing queries.\n 10+ years of inpatient coding or auditing experience with a mastery level expertise in both APR-DRG methodology. \nExperience developing audit selection criteria to identify APR-DRG coding errors and overpayments preferred\nExperience working with large data sets. \nAdept at identifying meaningful patterns, trends and root causes from data\nAdvanced analytical and problem-solving skills. \nIndustry knowledge specific to APR-DRG reimbursement, provider contracts, payer policies, and audit regulations\nExcellent oral and written communication skills \nEducation and Required Certification:\nBachelor’s degree in health information management, Healthcare Informatics or Health Care Administration\nActive AHIMA certification - RHIA, RHIT or CCS\nWork Experience Requirements\nExperience with encoder tools (3M, Trubridge)\nProficient in Microsoft Excel including advanced functions and pivot tables and Power Point\nExperience with AI tools preferred\nWhat We Offer:\nEXL Health offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with experienced, world-class Healthcare consultants. \nYou can expect to learn about many aspects of businesses that our clients engage in. You will also learn effective teamwork and time management skills - key aspects for personal and professional growth. \nWe provide guidance/ coaching to every employee through our mentoring program wherein every junior level employee is assigned as a senior level professional as advisors. \nSky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond. \nBenefits we offer are Healthcare, Vision, Dental and 401k options. \nThe posted base salary range is the hiring base salary range for this role. 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