Director, Diagnosis-Related Group Validation (DRGV)

OpenKrill; United States; On-site; USD 180,000 - 280,000; Full time

Job summary

Revecore is seeking a Director of Diagnosis-Related Group Validation (DRGV) to lead the development and launch of our DRGV service offering, expanding our Billing and Coding Optimization capabilities. You will define the operating model, workflows, staffing, and performance standards, partnering with Product, Data, AI, and Engineering teams to scale solutions and drive client value.

The role demands deep DRGV expertise, MS-DRG knowledge, and strong revenue integrity experience, with a focus on

Qualifications

• Hands-on DRGV coding experience and strong DRGV outcomes knowledge.
• MS-DRG classification and reimbursement methodology expertise.
• Strong understanding of revenue cycle and revenue integrity (charge capture, coding, and CDI).
• Experience interpreting payer contracts and claim adjudication processes.
• Experience designing, leading, or contributing to DRGV programs, including workflows and metrics.
• Experience developing and maintaining coding or reimbursement code tables.
• Experience partnering with Product/Engineering to translate requirements into scalable tech solutions.
• Understanding of how AI and automation can improve DRGV processes.
• Excellent communication skills for client discussions and solution development.

Responsibilities

• Define operating model, workflows, staffing, productivity metrics, and quality standards to scale the DRGV service.
• Provide SME support across DRGV, including coding, MS-DRG, revenue integrity, and claims.
• Collaborate with Product, Data, AI, Development, and Operations to translate DRGV needs into scalable processes and tech solutions.
• Identify opportunities to apply AI/automation to improve account selection, prioritization, and processing.
• Serve as liaison between DRGV SMEs and Product/Engineering for software requirements.
• Set performance expectations and monitor progress against goals and financial targets.
• Advise on pricing models, marketing strategy, and sales enablement for the DRGV offering.
• Support client-facing discussions with DRGV expertise during proposals and engagements.
• Work with BCO team to deliver DRGV services to clients.
• Drive cross-functional execution to align a new DRGV solution across the org.

Skills

DRGV expertise

MS-DRG classification

revenue cycle

coding & CDI

payer contracts understanding

DRGV programs leadership

coding tables

AI & automation

cross-functional leadership

sales support & communications

Job description

At Revecore, our work helps hospitals recover the revenue they've earned so they can continue serving patients and communities. Trusted by more than 1,300 hospitals across 48 states, we combine specialized expertise with proprietary technology to solve problems others can't. Just as importantly, we've built a workplace where people support one another, embrace innovation, and are trusted to do their best work.

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The Role: Director, Diagnosis-Related Group Validation (DRGV)

The Director, Diagnosis-Related Group Validation (DRGV) will lead the development and launch of Revecore’s DRGV service offering, expanding our Billing and Coding Optimization (BCO) capabilities in response to client demand. This role combines deep DRGV expertise with service-line strategy and execution, translating industry knowledge into a scalable operating model, technology-enabled workflows, staffing and performance standards, pricing, and go-to-market support.

Impact you will make:

• Define the operating model, workflows, staffing requirements, productivity metrics, quality standards, and industry benchmarks needed to scale the service line.
• Provide subject matter expertise across all aspects of DRGV, including coding, Medicare Severity Diagnosis-Related Group (MS-DRG) methodology, revenue integrity, and claims.
• Partner with Product, Data, AI, Development, and Operations teams to translate DRGV requirements into scalable processes and technology solutions.
• Identify opportunities to use AI and automation to improve account selection, prioritization, processing, productivity, and overall service delivery.
• Serve as the technical and operational liaison between DRGV subject matter experts and Product and Engineering teams, including supporting software development and complex code-table requirements.
• Establish performance expectations and metrics for the service line and monitor progress against implementation, operational, and financial goals.
• Advise on pricing models, marketing strategy, positioning, and sales enablement for the DRGV offering.
• Support client-facing sales efforts by providing DRGV expertise during prospect and client discussions.
• Partner with the BCO team responsible for delivering the service to clients.
• Drive execution across a matrixed organization, building alignment and organizational knowledge around a new solution

You’ll be successful if you have:

• Deep expertise in Diagnosis-Related Group Validation (DRGV), grounded in hands‑on coding experience and a strong understanding of the factors driving DRGV outcomes.
• 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, including operational workflows, staffing models, productivity metrics, quality standards, and industry benchmarks.
• Experience developing and maintaining complex coding or reimbursement code tables.
• Experience partnering with Product, Engineering, or software development teams to translate business requirements and subject matter expertise into scalable technology solutions.
• Understanding of how data, artificial intelligence (AI), and automation can improve DRGV account selection, prioritization, processing, and operational efficiency.
• Ability to lead cross‑functional initiatives, influence stakeholders, and drive execution across technical, operational, and commercial teams.
• Strong communication and client‑facing skills, with the ability to support solution development, sales discussions, and industry engagement.

Preferred Qualifications & Experience

• Experience with Diagnosis-Related Group Downgrades (DRGD).
• Experience within a vendor-side DRGV, payment integrity, revenue integrity, or healthcare revenue cycle organization.
• Experience launching or scaling a healthcare service line, product, or operational capability.
• Experience supporting client‑facing solutioning, sales enablement, or industry thought leadership.

Work at Home Requirements:

• A quiet, distraction‑free environment to work from in your home.
• A secure internet connection is required.
• Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads.
• The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive.

Must reside in the United States within one of the states listed below:

Alabama, Arkansas, Connecticut, Florida, Georgia, Iowa, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maine, Michigan, Minnesota, Missouri, Mississippi, North Carolina, Nebraska, New Hampshire, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota (CST Time Zone), Tennessee, Texas (CST Time Zone), Vermont, Virginia, Wisconsin, and West Virginia.

Revecore is an affirmative Action/Equal Opportunity Employer committed to providing equal employment opportunities for all applicants and employees. We make employment decisions without regard to any characteristic protected by applicable law and encourage individuals of all backgrounds to apply.

Employment is contingent upon eligibility to work in the United States, verification of employment history, and successful completion of a background check.