Director, Diagnosis-Related Group Validation

Job not on LinkedIn

🔥 15 hours ago

🏈 Alabama, Connecticut, +26 more states – Remote

🏈 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

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 10%

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Revecore

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

☁️ SaaS

🤝 B2B

Healthcare • SaaS • B2B

Revecore is a healthcare revenue recovery company that combines proprietary AI, claims intelligence, workflow automation, and clinical, legal, and reimbursement expertise to identify and recover missed revenue for hospitals and health systems. Their ReClaim™ platform and network intelligence use machine-learning models and payor rule engines trained on hundreds of millions of claims to automate decisioning, prioritize recoveries, manage complex claims (VA, auto accidents, workers' compensation, Medicaid), denials management, underpayment recovery, and accounts receivable acceleration. Revecore operates HIPAA-compliant, SOC 2-certified infrastructure and serves over 1,300 hospitals, emphasizing outcomes like increased reimbursement, faster reimbursement, and high denial overturn rates.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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