Director, DRG Validation
Core
Strategic leadership and operational management of the DRG Validation solution for pre-pay and post-pay payment integrity programs, driving innovation through AI, automation, and machine learning to improve coding accuracy and savings.
Role type
Director, DRG Validation (Strategic & Operational Leadership)
Builds
DRG Validation solution (pre-pay and post-pay payment integrity programs)
Domain
Healthcare Payer Services / Revenue Cycle Management / AI & Automation
Deliverable
production ML models
Required skills
Strategic planning, operational leadership, AI/ML strategy, data analytics, stakeholder management, financial performance management, regulatory compliance, global team management
Preferred skills
Experience with payment integrity programs, knowledge of inpatient coding and reimbursement methodologies, expertise in automation and workflow transformation
Technologies
Artificial Intelligence, Machine Learning, Automation tools, Analytics platforms
Responsibilities
Own strategic direction and growth of the DRG Validation solution; Lead a global organization of coding, clinical, and operational professionals; Drive innovation in AI, automation, and ML for coding accuracy; Establish governance processes and quality standards; Partner with executive leadership on market opportunities and competitive strategies; Manage multi-year plans for organizational growth and product innovation.
Seniority
Director, Strategic & Operational Leadership
