Senior Manager - Diagnosis-Related Group (DRG) Data Analyst

• The Senior Manager Diagnosis Related Group (DRG) SME will support the business
• team in evaluating trends on utilization of products / services based on
• historical data - such as care management trends, claim utilization, member
• attributes, to develop cost effective quality product / services. The ideal
• candidate retrieves, organizes and performs research/analysis on Medical Health
• Claim data primarily to identify root cause and is a proactive thinker,
• self-starter, who enjoys working in a fast-paced and challenging environment
• with the ability to work independently. Candidate should have a strong
• understanding of both inpatient MS-DRG/APR-DRG payment systems and have
• experience/knowledge in health care claims.  Additional experience with
• Outpatient, HH, SNF, BH, IRF, Professional, DME, HCD claims is a plus. Previous
• claims payment and auditing experience would also be beneficial and recommended.
• Understanding of Medical claim terminology and insurance terminology. Experience
• with payer policy, claim system limitations, provider contracting terms are
• highly recommended. Experience with Pre-Pay and Post-Pay code edit/rules
• development is recommended/encouraged as well.

Salary Range for this role is: $120k - $125k

For more information on benefits and what we offer please visit us

at https://www.exlservice.com/us-careers-and-benefits

RESPONSIBILITIES

• Pull and integrate data from disparate sources (e.g. claims,

membership/enrollment, etc.)

• Perform quality assurance reviews on data and document the findings
• Interpret, analyze and present key findings to internal team & business

partners

• Conduct deal reviews and work with appropriate stakeholders
• Publish the attribution status to all required stakeholders
• Research on issues related to attribution and co-ordinate with required

stakeholders to bring it to closure

• Provide user guide and maintain documentation on existing attribution

methodology

• Help develop the tools for quality and transparency for attribution
• Become the analytical, technical and business co-lead
• Coding responsibilities will include SQL and Python primarily

QUALIFICATIONS

• Must have:
• Minimum level of education desired for candidates in this position is a

bachelor's degree or equivalent experience

• 5-7 years of relevant hands-on data analysis experience
• 5-7 years of relevant medical claim experience with good understanding of

inpatient MS-DRG/APR-DRG payment systems.

• Strong Healthcare Insurance data experience
• Experience translating business, regulatory, and payment policy requirements

into actionable code edits/rules

• Demonstrates good written and verbal communication skills
• Experience using business tools to query large datasets, e.g., Microsoft SQL,

Databricks

• Able to present information to various audiences - technical and

non-technical

• Good to have:
• Ability to work with large data sets from multiple data sources.
• RHIA, RHIT, CCS Certification
• Excellent communication skills with strong background working directly with

coworkers and clientele to identify business objectives and establish

requirements

• Worked in a team environment and also coordinated with business/functional

team

• What we offer:
• EXL 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 highly experienced, world class analytics
• consultants.

• You can expect to learn 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

• EXL Health Analytics requires different skill sets at different levels within

• the organization. At EXL Analytics, we invest heavily in training you in all
• aspects of analytics as well as in leading analytical tools and techniques.

• We provide guidance/ coaching to every employee through our mentoring program

• wherein every junior level employee is assigned a senior level professional
• as advisors.

• Sky is the limit for our team members. The unique experiences gathered at EXL

sets the stage for further growth and development in our company and beyond.

• The posted base salary range is the hiring base salary range for this role.
• 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.

• EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and
• solutions company. We partner with clients using a data and AI-led approach to
• reinvent business models, drive better business outcomes and unlock growth with
• speed. EXL harnesses the power of data, analytics, AI, and deep industry
• knowledge to transform operations for the world’s leading corporations in
• industries including insurance, healthcare, banking and financial services,
• media and retail, among others. EXL was founded in 1999 with the core values of
• innovation, collaboration, excellence, integrity and respect. We are
• headquartered in New York and have more than 54,000 employees spanning six
• continents. For more information, visit www.exlservice.com
• [http://www.exlservice.com/].

• EXL never requires or asks for fees/payments or credit card or bank details
• during any phase of the recruitment or hiring process and has not authorized any
• agencies or partners to collect any fee or payment from prospective candidates.
• EXL will only extend a job offer after a candidate has gone through a formal
• interview process with members of EXL’s Human Resources team, as well as our
• hiring managers.

• EXL is the indispensable partner for leading businesses in data-led industries
• such as insurance, banking and financial services, healthcare, retail and
• logistics. We bring a unique combination of data, advanced analytics, digital
• technology and industry expertise to help our clients turn data into insights,
• streamline operations, improve customer experience, and transform their
• business. Our partnerships with clients are built on a foundation of
• collaboration – and we’ve been chosen as a partner by nine of the top ten
• leading US insurance companies, nine of the top 20 global banks, and six of the
• top ten US health care payers. We function as one team to make your goals our
• goals, whether that’s unlocking the value of generative AI or embedding
• analytics into workflows that reduce risk or power your growth. Clients choose
• EXL as their transformation partner for many reasons. Our geographic diversity
• make talent all over the world instantly accessible. Digital accelerators enable
• unmatched speed-to-value, letting you realize results fast. It’s our people that
• truly set us apart, though, including the 1,500 data scientists we have
• dedicated to our generative AI practice. And our more than twenty years of
• experience in delivering business services, garnering stellar client references,
• and maintaining a solid balance sheet are reassuring to our C-suite clients.
• Find out for yourself why clients, employees, and analysts think we’re some of
• the best in the business. Contact us to see how we can help you achieve your
• goals.