DRG Audit Program Director — Validation & Compliance Leader

CorVel Corporation; Fort Worth (TX); On-site; USD 150,000 - 190,000; Full time

Benefits offered by this job

Medical (HDHP) with Pharmacy

Dental

Vision

Long Term Disability

Health Savings Account

Flexible Spending Account Options

Life Insurance

Accident Insurance

Critical Illness Insurance

Pre-paid Legal Insurance

Parking and Transit FSA

401K

ROTH 401K

Paid time off

Job summary

CERIS, a division of CorVel Corporation, seeks a Director to lead the DRG Audit Program, overseeing clinical validation, coding accuracy, and payment integrity across the DRG lifecycle.

You will manage teams of auditors, partner with operations, policy, product, analytics, and sales, and provide executive reporting, training, and strategic recommendations.

Travel as needed; strong knowledge of MS-DRG/APR-DRG, ICD-10-CM/PCS, and regulatory requirements is essential.

Qualifications

• Bachelor's degree in Health Information Management, Nursing, Healthcare Administration, or related field; Master’s preferred.
• One or more certifications such as RHIA, RHIT, CCS, or CIC preferred.
• Minimum 7–10 years progressive experience in DRG coding, clinical validation, medical auditing, or payment integrity.

Responsibilities

• Develop and execute the strategic vision for the DRG Audit Program.
• Provide leadership for all aspects of the DRG audit lifecycle.
• Establish KPIs, quality standards, and SLAs with data-driven insights.
• Lead and mentor teams of clinical, coding, and readmission auditors.
• Serve as SME for DRG validation, documentation, and reimbursement rules.
• Collaborate with Operations, Policy, Product, Technology, Analytics, Sales, and Client Services.
• Provide executive reporting, client support, and strategic recommendations.
• Travel multiple times per year as required.
• Additional duties as assigned.

Skills

DRG validation

Clinical documentation

Healthcare reimbursement

Data analysis

Leadership

Stakeholder management

MS-DRG

ICD-10-CM/PCS

Regulatory compliance

Auditing

Education

Bachelor's in HIM / Health Administration / Nursing

Master's degree preferred

RHIA / RHIT / CCS / CIC certifications preferred

Tools

Audit platforms

Microsoft Office

Job description

CERIS, a division of CorVel Corporation, seeks a Director to lead the DRG Audit Program, overseeing clinical validation, coding accuracy, and payment integrity across the DRG lifecycle.

You will manage teams of auditors, partner with operations, policy, product, analytics, and sales, and provide executive reporting, training, and strategic recommendations.

Travel as needed; strong knowledge of MS-DRG/APR-DRG, ICD-10-CM/PCS, and regulatory requirements is essential.