Director, DRG Validation & Revenue Optimization

Revecore; South Dakota; Remote; USD 140,000 - 200,000; Full time

Job summary

Revecore seeks a Director of Diagnosis-Related Group Validation (DRGV) to lead the development and launch of its DRGV service, expanding Billing and Coding Optimization capabilities with a scalable operating model and tech-enabled workflows.

You will define operating models, staffing, metrics, and go-to-market plans while collaborating with Product, Data, AI, Development, and Operations to deliver high-quality, efficient DRGV solutions and pricing strategies.

Qualifications

• Deep DRGV expertise with hands-on coding experience.
• Expert-level MS-DRG classification and reimbursement knowledge.
• Strong understanding of revenue cycle, charge capture, coding, and CDI.

Responsibilities

• Define operating model, workflows, staffing requirements, productivity metrics, quality standards, and benchmarks to scale the service line.
• Provide subject matter expertise across all aspects of DRGV, including coding, MS-DRG, revenue integrity, and claims.
• Partner with Product, Data, AI, Development, and Operations 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 liaison between DRGV SMEs and Product/Engineering; support software development and complex code-table requirements.
• Establish performance expectations and metrics for the service line and monitor implementation, operations, and financial goals.
• Advise on pricing models, marketing strategy, positioning, and sales enablement for the DRGV offering.
• Support client-facing sales efforts with DRGV expertise during discussions.
• Partner with BCO team delivering the service to clients.
• Drive execution across a matrixed organization to build alignment around a new solution.

Skills

DRGV expertise

MS-DRG knowledge

Revenue integrity

Coding experience

AI/automation

Cross-functional leadership

Payer contracts knowledge

Job description

Revecore seeks a Director of Diagnosis-Related Group Validation (DRGV) to lead the development and launch of its DRGV service, expanding Billing and Coding Optimization capabilities with a scalable operating model and tech-enabled workflows.

You will define operating models, staffing, metrics, and go-to-market plans while collaborating with Product, Data, AI, Development, and Operations to deliver high-quality, efficient DRGV solutions and pricing strategies.