Remote Director, DRG Validation & Revenue Integrity

Openkrill; United States; Remote; 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

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