Clinical Director, Revenue Integrity – DRG Validation

🕒 September 17

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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CorroHealth

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

CorroHealth is a leading provider of clinically led healthcare analytics and technology-driven solutions, focused on enhancing the financial performance of hospitals and health systems. Their integrated solutions and advanced technologies aim to optimize the entire revenue cycle, offering services such as revenue cycle management, clinical documentation, medical coding, and denials management. With a commitment to improving financial health through intelligent technology and expert guidance, CorroHealth addresses complex payer-provider relationships and supports efficient healthcare operations.

📋 Description

• Develop and implement CDI strategies, policies, and workflows to optimize documentation processes and improve clinical outcomes and data integrity • Own the strategy, operations, quality, and financial performance of the pre-bill DRG validation service line • Design, execute, and continuously improve the pre-bill DRG validation program across assigned client engagements • Establish program goals, KPIs, service-level commitments, and performance reporting for executive leadership and clients • Develop review methodologies, case selection logic, and prioritization criteria • Support business development through subject-matter expertise, proposal input, and client presentations • Serve as senior clinical and coding authority for DRG validation, clinical validation, and query practice • Adjudicate escalated and complex cases, including clinical validation disputes, conflicting documentation, and high-dollar DRG shifts • Maintain quality assurance programs with inter-rater reliability targets, second-level review, and corrective action • Recruit, onboard, develop, and retain clinical validators, DRG auditors, and CDI professionals • Set productivity and quality expectations; conduct evaluations; manage coaching, development plans, and corrective action • Deliver ongoing education on regulatory changes, coding updates, and clinical validation topics • Manage staffing models, capacity planning, and workload distribution • Act as executive point of contact for client HIM, CDI, Compliance, and Revenue Cycle leadership • Lead client governance meetings, present outcomes and trend analyses, and recommend documentation and coding improvements • Resolve client escalations and manage program changes, scope adjustments, and issue remediation • Ensure compliance with HIPAA, OIG guidance, and company policies; support audits • Partner with Analytics on dashboards and reporting for DRG changes, financial impact, query responses, denials, and reviewer performance • Collaborate with Technology and Product teams on workflow tooling, case routing, and automation • Manage program budget, labor costs, vendor relationships, and profitability targets • Travel for client meetings, on-site assessments, and company events

🎯 Requirements

• Clinical degree required: Registered Nurse (BSN or ADN with active licensure), Doctor of Medicine (MD/DO), Physician Assistant, Nurse Practitioner, or equivalent clinical credential from an accredited institution • Bachelor's degree required • CDI certification: CCDS (ACDIS) or CDIP (AHIMA) required • Minimum ten (10) years of hands-on experience performing and/or overseeing DRG validation reviews, including MS-DRG and APR-DRG methodologies, clinical validation, and pre-bill review workflows • Minimum five (5) years of people management experience leading clinical, coding, or CDI teams, including direct supervision of managers or team leads • Experience managing programs in a hospital, health system, payer, or healthcare consulting/outsourcing environment • Proven track record of delivering measurable financial and quality outcomes through DRG validation or CDI programs • Expert command of ICD-10-CM/PCS, MS-DRG and APR-DRG grouping logic, CC/MCC capture, SOI/ROM, and Coding Clinic guidance • Deep understanding of compliant query practice, clinical validation standards, and payer denial and appeal processes • Strong analytical skills and ability to present findings to executive and clinical audiences • Exceptional written and verbal communication and ability to influence physicians, HIM, and finance leaders • Proficiency with encoders, CDI platforms, and EHR systems such as 3M/Solventum, Epic, and Cerner/Oracle Health • Standard business hours with flexibility to support client time zones and deadlines • Master's degree (MSN, MHA, MBA, or related) preferred • CCS (AHIMA) certification preferred • Preferred experience in multi-client outsourced services or consulting environments; building or scaling pre-bill or concurrent review programs; pediatric, academic medical center, or specialty inpatient populations; AI-assisted coding or CDI technologies • Six Sigma, Lean, or PMP certification preferred

🏖️ Benefits

• Annual performance-based bonus • Comprehensive medical, dental, and vision coverage • 401(k) with company match • Paid time off and holidays • Continuing education and certification maintenance support • Remote work arrangement • Flexible schedule to support client time zones and deadlines

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