Director, DRGV & Revenue Integrity Strategy

Revecore; Massachusetts; A distancia; USD 180.000 - 240.000; Jornada completa

Descripción de la vacante

Revecore is recruiting a Director of Diagnosis-Related Group Validation (DRGV) to lead development and launch of our DRGV service offering, expanding our BCO capabilities. You'll shape the operating model, workflows, staffing, and metrics while partnering with Product, Data, AI, and Engineering teams to create scalable, technology-enabled processes.

Strong DRGV, MS-DRG, and revenue integrity background required.

Formación

• Deep DRGV expertise with hands-on coding experience and DRGV outcomes understanding.
• MS-DRG classification and reimbursement methodology knowledge.
• Revenue integrity including charge capture and CDI concepts.
• Experience interpreting payer contracts and claim adjudication processes.
• Experience designing or scaling DRGV programs and workflows.
• Experience translating business needs to scalable technology solutions.

Responsabilidades

• Define operating model, workflows, staffing, productivity metrics, and quality standards for the DRGV service line.
• Provide SME across DRGV including coding, MS-DRG, and claims.
• Partner with Product/Data/AI/Dev/Operations to translate DRGV requirements into scalable processes and tech.
• Identify opportunities to use AI/automation to improve account selection and processing.
• Serve as liaison between DRGV SMEs and Product/Engineering on code-table requirements.
• Establish performance metrics and monitor progress toward goals.
• Advise on pricing models, marketing strategy, and sales enablement for DRGV offering.
• Support client discussions with DRGV expertise during prospecting and engagements.
• Collaborate with BCO team to deliver services to clients.
• Drive execution across a matrix organization for new solutions.

Conocimientos

DRGV expertise

MS-DRG knowledge

Revenue cycle understanding

Payer contracts interpretation

DRGV program leadership

Cross-functional collaboration

AI/automation familiarity

Technical collaboration with Product/"

Communication with clients

Herramientas

Coding tables

Descripción del empleo

Revecore is recruiting a Director of Diagnosis-Related Group Validation (DRGV) to lead development and launch of our DRGV service offering, expanding our BCO capabilities. You'll shape the operating model, workflows, staffing, and metrics while partnering with Product, Data, AI, and Engineering teams to create scalable, technology-enabled processes.

Strong DRGV, MS-DRG, and revenue integrity background required.