Director, DRG Validation
Core
Strategic leadership of DRG Validation solutions for pre-pay and post-pay payment integrity programs, driving operational performance, innovation, and growth for healthcare payers and providers.
Role type
Director, Healthcare Payment Integrity & Operations
Builds
Scalable DRG Validation solutions and operational workflows for healthcare clients
Domain
Healthcare Payer Operations / Revenue Cycle Management
Deliverable
production ML models | product features | dashboards & analysis | client delivery
Required skills
DRG validation, inpatient coding, reimbursement integrity, clinical audit, strategic leadership, operational transformation, automation, AI/ML strategy, global team management, compliance governance
Preferred skills
Registered Nurse (RN) licensure, global team leadership, AI/automation implementation, pre-pay/post-pay program experience
Technologies
Machine learning, automation tools, analytics platforms, decision-support systems
Responsibilities
Own strategic direction and performance of DRG Validation solution; Lead global teams of coding and clinical professionals; Drive operational excellence and continuous improvement; Partner with Product/Tech on innovation and automation; Ensure compliance with coding standards and regulations; Translate industry trends into strategic business initiatives
Seniority
Director, strategic leadership & global operations