Senior Operations Manager - Diagnosis-Related Group (DRG), Healthcare

The Manager of Operations ensures client savings and internal revenue are achieved. The Manager of Operations is responsible for planning, coordinating, and directing the activities of the audit program, ensuring staff is well trained, knowledgeable, responsive, and adherent to client SLAs. The Manager of Operations  has day to day oversight of program inventory, aging, issues, and risks, and is able to work across functional areas/departments to achieve corporate/division goals. The Manager of Operation provides regular program updates to clients and senior leaders, prepares for and participates in monthly/quarterly QBRs and new client implementations. The Operations Manager understands/manages staffing needs, tools, and training requirements.

A brief coding/auditing assessment may be included as part of the interview process

Salary Range: $110,000 – $125,000 (based on experience, skills, and qualifications)
Location: 100% Remote (U.S.-based)

Up to 5% annual travel (for team meetings and limited client onsite engagements.)

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

The posted range is the hiring range for this role — a subset of the broader range available to employees over time — and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.

Revenue Management: Ensures client savings and internal revenue goals are achieved

• Ensures a pipeline of selected cases are placed in the workflows each month
• Ensures records are requested in a timely manner each month for all clients and a good process exists
•   for daily receipt of records
• Ensures daily productivity goals are achieved and tracks if audited claims will result in savings/revenue
• Ensures revenue/findings files are submitted each month in a timely manner and a returning file is received for invoicing
• Ensures invoicing is performed timely each month
• Ensures record fees and client confirmed overpayments are imported into audit system for tracking
•   future forecasting and reporting
• Understands factors that generate/prevent revenue and solves issues that puts savings/revenue at risk

Performance Management: Ensures employees are aware, connected and accountable to program goals

• Ensures productivity and quality goals are established and communicated to all employees
• Ensures employees are provided with monthly one on ones (PIP/Counseling when below standard)
• Ensures team meetings are held to communicate with staff (performance, issues, risks, updates, plans)
• Provides training (re-training) coaching and development to ensure employees can be successful in their role
• Builds a high performance team and strives for operational excellence

Client Management:

• Provides client with performance updates as needed and/or when scheduled
• Ensures team is responsive to client emails/requests and provides quality, satisfactory responses
• Works with clinical staff/leaders to prepare for client presentations, address issues, and provide appropriate updates

Continuous Improvement:

• Understands issues, barriers, performance gaps and creates action plans to improve results
• Works across functions to solve issues and improve results (Selections, Workflows, IT, Implementations)
• Looks for ways to continuous develop self and others
• Brings forth at least 1 new solution/improvement per quarter
• Assist others as needed (not all inclusive)
• Conduct all job functions and responsibilities in accordance with all company Compliance, Information Security and Regulatory policies, procedures and programs.

Supervisory Responsibilities: 

Supervisors, clinical and non-clinical, coordinators. Works hand in hand with Clinical Leaders.

• Bachelor’s degree or equivalent work experience in clinical auditing
• Minimum 5-8  years or equivalent work exp