Manager, Payer Clinical Services (DRG)

At Trend Health Partners , a tech-enabled payment integrity company, our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows. Joining Trend Health Partners means becoming a part of a dynamic growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more. Position Summary The Manager, Payer Clinical Services is primarily responsible for overseeing and supporting the Clinical Coding Team by creating an environment that demonstrates exceptional customer service for clients through high-quality reviews, reporting, education, and operational support. This role ensures each coding team member has the knowledge, training, tools, and support needed to exceed business objectives. Role and Responsibilities Oversee clinical/coding DRG audits, including MS-DRG, APR-DRG, readmission, and short-stay reviews, to ensure accuracy and compliance with internal policies and industry-standard guidelines. Identify gaps and improvement opportunities and provide staff education to enhance audit quality and drive revenue performance. Apply appropriate industry-standard coding guidelines, payer policies, and medical journal references relevant to audit review. Maintain strong client relationships through accurate clinical and coding audits, continued understanding of client issues and needs, and compliance with payer policies, procedures, guidelines, and continuum-of-care requirements. Identify client trends related to coding denials and report findings to the clinical team and clients, ensuring client issues are thoroughly acknowledged. Oversee current st