Director, DRG Validation & Revenue Integrity

Revecore; Alabama; Remote; USD 180.000 - 240.000; Vollzeit

Zusammenfassung

Revecore is seeking a Director of Diagnosis-Related Group Validation (DRGV) to lead development and launch of the DRGV service offering within our Billing and Coding Optimization (BCO) capabilities. The role blends DRGV expertise with service-line strategy, shaping workflows, staffing, pricing, and go-to-market plans.

You will define the operating model, set performance standards, and collaborate with Product, Data, AI, and Engineering teams to deliver scalable, tech-enabled DRGV solutions while

Qualifikationen

• Deep DRGV expertise with hands-on coding experience.
• Expert MS-DRG classification and reimbursement knowledge.
• Strong understanding of revenue cycle, charge capture, and CDI.
• Experience interpreting payer contracts and claim adjudication.
• Experience designing or leading DRGV programs and staffing models.
• Ability to translate business requirements into scalable technology solutions.

Aufgaben

• Define operating model, workflows, staffing, productivity metrics, and quality standards for DRGV service.
• Provide SME guidance across DRGV, MS-DRG, revenue integrity, and claims.
• Partner with Product, Data, AI, Development, and Operations to build scalable processes and tech solutions.
• Identify AI/automation opportunities to improve DRGV account selection and processing.
• Lead cross-functional initiatives and drive execution across teams.

Kenntnisse

DRGV expertise

MS-DRG knowledge

Revenue integrity

CDI

Payer contracts

Solution development

Cross-functional leadership

Communication

Jobbeschreibung

Revecore is seeking a Director of Diagnosis-Related Group Validation (DRGV) to lead development and launch of the DRGV service offering within our Billing and Coding Optimization (BCO) capabilities. The role blends DRGV expertise with service-line strategy, shaping workflows, staffing, pricing, and go-to-market plans.

You will define the operating model, set performance standards, and collaborate with Product, Data, AI, and Engineering teams to deliver scalable, tech-enabled DRGV solutions while