Director, Diagnosis-Related Group Validation

This is a fully remote position, open to applicants in Alabama, +27 more states.

📋 Description

• Oversee the development and launch of Revecore’s DRGV service offering.

• Establish the operating model, workflows, staffing needs, productivity metrics, quality standards, and industry benchmarks.

• Offer subject matter expertise in DRGV, coding, MS-DRG methodology, revenue integrity, and claims.

• Collaborate with Product, Data, AI, Development, and Operations teams to create scalable processes and technological solutions.

• Identify opportunities to leverage AI and automation for account selection, prioritization, processing, productivity, and service delivery.

• Act as the technical and operational bridge between DRGV subject matter experts and Product and Engineering teams.

• Assist in software development and complex code-table requirements.

• Set performance expectations and metrics while monitoring implementation, operational, and financial objectives.

• Provide guidance on pricing models, marketing strategies, positioning, and sales enablement.

• Support client-facing sales initiatives during prospect and client interactions.

• Collaborate with the BCO team in delivering services to clients.

• Drive execution across a matrixed organization and foster alignment around the new solution.

⛳️ Requirements

• Extensive expertise in Diagnosis-Related Group Validation (DRGV), based on hands-on coding experience.

• Advanced knowledge of Medicare Severity Diagnosis-Related Group (MS-DRG) classification and reimbursement methodology.

• Strong comprehension of revenue cycle and revenue integrity, encompassing charge capture, charging patterns, coding, and Clinical Documentation Integrity (CDI).

• Experience in interpreting payer contracts, reimbursement terms, and claim adjudication processes.

• Proven experience in designing, leading, or significantly contributing to DRGV programs.

• Experience in developing and managing complex coding or reimbursement code tables.

• Background in partnering with Product, Engineering, or software development teams to translate requirements into scalable technology solutions.

• Familiarity with data, artificial intelligence (AI), and automation as applied to DRGV.

• Ability to spearhead cross-functional initiatives and drive execution across technical, operational, and commercial teams.

• Strong communication and client-facing abilities.

• Preferred: Experience with Diagnosis-Related Group Downgrades (DRGD).

• Preferred: Experience within a vendor-side DRGV, payment integrity, revenue integrity, or healthcare revenue cycle organization.

• Preferred: Experience in launching or scaling a healthcare service line, product, or operational capability.

• Preferred: Experience supporting client-facing solution development, sales enablement, or industry thought leadership.

• Must reside in the United States in one of the designated states.

• Eligibility to work in the United States.

• Successful completion of a background check.

🏝️ Benefits

• Remote work from home.

• Quiet, distraction-free home work environment.

• Secure internet connection.

• Home internet speeds exceeding 20 Mbps download and 10 Mbps upload.

• Workspace accommodating workstation equipment and related materials.

• Affirmative Action/Equal Opportunity Employer.

• Interview recording/transcription alternatives available upon request.