DRG (Diagnosis-Related Group) Business Solutions Lead
Core
Clinical-coding domain authority translating DRG audit expertise into product capability for trustworthy AI in healthcare payment integrity.
Role type
Senior IC DRG Business Solutions Lead
Builds
AI-driven audit technology and product features for health plans
Domain
Healthcare / Payment Integrity / AI & NLP
Deliverable
production ML models | product features
Required skills
DRG audit expertise, ICD-10-CM/PCS guidelines, AHA Coding Clinic, CMS POA Reporting Guidelines, appeal defense experience, payer contract language, clinical entity extraction, prompt library definition, model output validation
Preferred skills
Product management partnership, generative AI/NLP familiarity, agile tools (Jira/Confluence), startup environment experience
Technologies
Azure DevOps, Jira, Confluence
Responsibilities
Define product requirements and audit methodologies; translate coding guidelines into structured audit logic; maintain DRG audit prompt library; map audit signals to data domains; partner with data science on NLP pipeline targets; review model outputs and drive refinement; represent customer voice in product lifecycle; develop test scenarios for new audit capabilities
Seniority
Senior, hands-on IC