The Role: Director, Diagnosis-Related Group Validation (DRGV)
The Director, Diagnosis-Related Group Validation (DRGV) will lead the development and launch of Revecore's DRGV service offering, expanding our Billing and Coding Optimization (BCO) capabilities in response to client demand. This role combines deep DRGV expertise with service-line strategy and execution, translating industry knowledge into a scalable operating model, technology-enabled workflows, staffing and performance standards, pricing, and go-to-market support.
Impact you will make: - 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
You'll be successful if you have:- 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.
Preferred Qualifications & Experience- 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.
Work at Home Requirements:- A quiet, distraction-free environment to work from in your home.
- A secure internet connection is required.
- Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads.
- 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.
