Director, Diagnosis-Related Group Validation

🕒 Outubro 9

🏈 Alabama, Connecticut, +26 estados a mais – Remoto

🏈 Alabama – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🌾 Nebraska – Remote 🗻 New Hampshire – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

👻 Score fantasma 17%

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• Aberta há 35 dias.
• As vagas desta empresa costumam ser preenchidas em 22 dias.
• Sem salário divulgado.

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Revecore

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

🏥 Saúde

☁️ SaaS

🤝 B2B

Healthcare • SaaS • B2B

A Revecore é uma empresa de recuperação de receita na área da saúde que combina inteligência artificial proprietária, inteligência de reivindicações, automação de fluxo de trabalho e expertise clínica, jurídica e de reembolso para identificar e recuperar receitas perdidas para hospitais e sistemas de saúde. Sua plataforma ReClaim™ e inteligência de rede utilizam modelos de machine learning e mecanismos de regras de pagadores treinados em centenas de milhões de reivindicações para automatizar decisões, priorizar recuperações, gerenciar reivindicações complexas (VA, acidentes de trânsito, compensação de trabalhadores, Medicaid), gestão de negações, recuperação de pagamentos insuficientes e aceleração de contas a receber. A Revecore opera uma infraestrutura compatível com HIPAA, certificada pela SOC 2 e atende mais de 1. 300 hospitais, enfatizando resultados como aumento de reembolso, reembolso mais rápido e altas taxas de reversão de negações.

Descrição

• Lead the development and launch of Revecore’s DRGV service offering • Define the operating model, workflows, staffing requirements, productivity metrics, quality standards, and industry benchmarks • Provide subject matter expertise in DRGV, coding, MS-DRG methodology, revenue integrity, and claims • Partner with Product, Data, AI, Development, and Operations teams on scalable processes and technology solutions • Identify opportunities to use AI and automation for account selection, prioritization, processing, productivity, and service delivery • Serve as the technical and operational liaison between DRGV subject matter experts and Product and Engineering teams • Support software development and complex code-table requirements • Establish performance expectations and metrics and monitor implementation, operational, and financial goals • Advise on pricing models, marketing strategy, positioning, and sales enablement • Support client-facing sales efforts during prospect and client discussions • Partner with the BCO team delivering services to clients • Drive execution across a matrixed organization and build alignment around the new solution

🎯 Requisitos

• Deep expertise in Diagnosis-Related Group Validation (DRGV), grounded in hands-on coding experience • Expert-level knowledge of Medicare Severity Diagnosis-Related Group (MS-DRG) classification and reimbursement methodology • Strong understanding of revenue cycle and revenue integrity, including charge capture, charging patterns, coding, and Clinical Documentation Integrity (CDI) • Experience interpreting payer contracts, reimbursement terms, and claim adjudication processes • Experience designing, leading, or significantly contributing to DRGV programs • Experience developing and maintaining complex coding or reimbursement code tables • Experience partnering with Product, Engineering, or software development teams to translate requirements into scalable technology solutions • Understanding of data, artificial intelligence (AI), and automation applied to DRGV • Ability to lead cross-functional initiatives and drive execution across technical, operational, and commercial teams • Strong communication and client-facing skills • 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 launching or scaling a healthcare service line, product, or operational capability • Preferred: Experience supporting client-facing solutioning, sales enablement, or industry thought leadership • Must reside in the United States in one of the listed states • Eligibility to work in the United States • Successful completion of a background check

🏖️ Benefícios

• Remote work from home • Quiet, distraction-free home work environment • Secure internet connection • Home internet speeds greater than 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

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