Revecore - Director, Diagnosis-Related Group Validation (DRGV)
Requirements
• Deep expertise in Diagnosis-Related Group Validation (DRGV), grounded in hands-on coding experience and a strong understanding of the factors driving DRGV outcomes. • Expert-level knowledge of Medicare Severity Diagnosis-Related Group (MS-DRG) classification and reimbursement methodology. • Strong understanding of revenue cycle and revenue integrity, including charge capture, charging patterns, coding, and Clinical Documentation Integrity (CDI). • Experience interpreting payer contracts, reimbursement terms, and claim adjudication processes. • Experience designing, leading, or significantly contributing to DRGV programs, including operational workflows, staffing models, productivity metrics, quality standards, and industry benchmarks. • Experience developing and maintaining complex coding or reimbursement code tables. • Experience partnering with Product, Engineering, or software development teams to translate business requirements and subject matter expertise into scalable technology solutions. • Understanding of how data, artificial intelligence (AI), and automation can improve DRGV account selection, prioritization, processing, and operational efficiency. • Ability to lead cross-functional initiatives, influence stakeholders, and drive execution across technical, operational, and commercial teams. • Strong communication and client-facing skills, with the ability to support solution development, sales discussions, and industry engagement. • Experience with Diagnosis-Related Group Downgrades (DRGD). • Experience within a vendor-side DRGV, payment integrity, revenue integrity, or healthcare revenue cycle organization. • Experience launching or scaling a healthcare service line, product, or operational capability. • Experience supporting client-facing solutioning, sales enablement, or industry thought leadership. • A quiet, distraction-free environment to work from in your home. • A secure internet connection is required. • The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive. • Must reside in the United States within one of the states listed below: • Alabama, Arkansas, Connecticut, Florida, Georgia, Iowa, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maine, Michigan, Minnesota, Missouri, Mississippi, North Carolina, Nebraska, New Hampshire, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota (CST Time Zone), Tennessee, Texas (CST Time Zone), Vermont, Virginia, Wisconsin, and West Virginia.
Responsibilities
• Define the operating model, workflows, staffing requirements, productivity metrics, quality standards, and industry benchmarks needed to scale the service line. • Provide subject matter expertise across all aspects of DRGV, including coding, Medicare Severity Diagnosis-Related Group (MS-DRG) methodology, revenue integrity, and claims. • Partner with Product, Data, AI, Development, and Operations teams to translate DRGV requirements into scalable processes and technology solutions. • Identify opportunities to use AI and automation to improve account selection, prioritization, processing, productivity, and overall service delivery. • Serve as the technical and operational liaison between DRGV subject matter experts and Product and Engineering teams, including supporting software development and complex code-table requirements. • Establish performance expectations and metrics for the service line and monitor progress against implementation, operational, and financial goals. • Advise on pricing models, marketing strategy, positioning, and sales enablement for the DRGV offering. • Support client-facing sales efforts by providing DRGV expertise during prospect and client discussions. • Partner with the BCO team responsible for delivering the service to clients. • Drive execution across a matrixed organization, building alignment and organizational knowledge around a new solution
Benefits
• (If you're an active employee, please visit the Internal Career Site to apply.) • No, I am not an Active Employee • Yes, I am an Active Employee • Revecore conducts video interviews as part of our hiring process. These interviews will be recorded and transcribed for internal business purposes, including evaluation, training, documentation, and identity verification. • will be • Please indicate your preference below: • I consent to Revecore recording and transcribing my interviews as part of the hiring process. I understand that these recordings will be used solely for internal purposes and managed in accordance with Revecore’s data privacy and confidentiality policies. • I do not consent to my interviews being recorded and transcribed. I request that alternative arrangements be made where possible. • Please confirm the following: • I certify that all information provided in my employment application, resume, and any supporting documents is true, complete, and accurate to the best of my knowledge. I authorize Revecore to verify the information provided, including contacting references, former employers, and educational institutions as permitted by law. I understand that any false statements, omissions, or misrepresentations may result in the rejection of my application or termination of employment. I understand that submitting an application does not guarantee employment and that any offer of employment may be contingent upon successful completion of required pre-employment screenings and signing applicable employment documents. • By selecting "Yes," I acknowledge that my electronic confirmation has the same legal effect as my handwritten signature. • Yes, I acknowledge and agree to the statements above. • No, I do not acknowledge or agree to the statements above. • Decline to self-identify • Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. • Hispanic or Latino • White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. • White • Black or African American (Not Hispanic or Latino) - A person having origins in any of the Black racial groups of Africa. • Black or African American • Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. • Native Hawaiian or Other Pacific Islander • Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. • Asian • American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. • American Indian or Alaska Native • Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races. • Two or More Races • Hispanic or Latino • White (Not Hispanic or Latino) • Black or African American (Not Hispanic or Latino) • Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) • Asian (Not Hispanic or Latino) • American Indian or Alaska Native (Not Hispanic or Latino) • Two or More Races (Not Hispanic or Latino) • I identify as one or more of the classifications of protected veteran listed above • I am not a protected veteran
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