Director, Pre-bill DRG Validation Program

CorroHealth

. Own the end-to-end design, execution, and continuous improvement of the pre-bill DRG validation program across assigned client engagements .

Posted 9/17/2026full-timeRemote • United StatesLeadWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in DRG validation, clinical validation, and coding compliance, with a strong focus on program management, quality assurance, and team leadership. Proficient in interpreting complex data and delivering impactful presentations to executive stakeholders.

Highest-signal resume keywords

DRG ValidationICD-10-CM/PCS ComplianceCDI Certification (CCDS or CDIP)People Management ExperienceAnalytical Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

DRG MethodologiesClinical ValidationPre-Bill Review WorkflowsMS-DRG and APR-DRG Grouping LogicQuery Practice StandardsFinancial Outcome DeliveryQuality Assurance Program ManagementProgram Budget ManagementData InterpretationCoding Clinic Guidance

Soft Skills

Executive PresenceExceptional CommunicationInfluencing SkillsCoaching and DevelopmentProblem-Solving

Tools & Technologies

3M/SolventumEpicCerner/Oracle HealthCDI PlatformsEncoders

Certifications & Qualifications

Registered Nurse (BSN or ADN)Doctor of Medicine (MD/DO)Physician AssistantNurse PractitionerCDI Certification (CCDS or CDIP)Coding Certification (CCS)

Industry Keywords

Healthcare ConsultingCompliancePayer PoliciesHIMRevenue Cycle ManagementClinical Documentation ImprovementAudit SupportMulti-Client Outsourced ServicesPediatric PopulationsAI-Assisted Coding

Tech Stack

Tools & technologies

OraclePMP

About the role

Key responsibilities & impact

Own the end-to-end design, execution, and continuous improvement of the pre-bill DRG validation program across assigned client engagements
Establish program goals, KPIs, and service-level commitments; report performance to executive leadership and clients
Develop and maintain review methodologies, case selection logic, and prioritization criteria
Identify opportunities to expand service offerings and support business development through subject-matter expertise, proposal input, and client presentations
Serve as senior clinical and coding authority for DRG validation, clinical validation, and query practice
Ensure reviews comply with ICD-10-CM/PCS Official Guidelines, AHA Coding Clinic, CMS regulations, ACDIS/AHIMA query guidelines, and payer policies
Adjudicate escalated and complex cases, including clinical validation disputes, conflicting documentation, and high-dollar DRG shifts
Maintain a quality assurance program with inter-rater reliability targets, second-level review, and corrective action
Recruit, onboard, develop, and retain clinical validators, DRG auditors, and CDI professionals
Set productivity and quality expectations; conduct evaluations; manage coaching, development plans, and corrective action
Design and deliver education on regulatory changes, coding updates, and clinical validation topics
Manage staffing models, capacity planning, and workload distribution
Act as executive point of contact for client HIM, CDI, Compliance, and Revenue Cycle leadership
Lead client governance meetings, present outcomes and trend analyses, and provide documentation and coding improvement recommendations
Resolve client escalations and manage program changes, scope adjustments, and issue remediation
Ensure compliance with HIPAA, OIG guidance, and CorroHealth policies; support audits
Partner with Analytics on dashboards and reporting for DRG changes, financial impact, query response, denials, and reviewer performance
Collaborate with Technology and Product teams on workflow tooling, case routing, and automation
Manage program budget, labor costs, vendor relationships, and profitability targets

Requirements

What you’ll need

Registered Nurse (BSN or ADN with active licensure), Doctor of Medicine (MD/DO), Physician Assistant, Nurse Practitioner, or equivalent clinical credential from an accredited institution
Bachelor's degree required
Master's degree (MSN, MHA, MBA, or related) preferred
CDI certification: CCDS (ACDIS) or CDIP (AHIMA) required
Coding certification: CCS (AHIMA) preferred
Minimum 10 years of hands-on experience performing and/or overseeing DRG validation reviews, including MS-DRG and APR-DRG methodologies, clinical validation, and pre-bill review workflows
Minimum 5 years of people management experience leading clinical, coding, or CDI teams, including direct supervision of managers or team leads
Experience managing programs in a hospital, health system, payer, or healthcare consulting/outsourcing environment
Proven track record of delivering measurable financial and quality outcomes through DRG validation or CDI programs
Expert command of ICD-10-CM/PCS, MS-DRG and APR-DRG grouping logic, CC/MCC capture, SOI/ROM, and Coding Clinic guidance
Deep understanding of compliant query practice, clinical validation standards, and payer denial and appeal processes
Strong analytical skills and ability to interpret program data and present findings to executive and clinical audiences
Executive presence, exceptional written and verbal communication, and ability to influence physicians, HIM, and finance leaders
Proficiency with encoders, CDI platforms, and EHR systems such as 3M/Solventum, Epic, and Cerner/Oracle Health
Standard business hours with flexibility to support client time zones and deadlines
Preferred: experience in a multi-client outsourced services or consulting environment
Preferred: experience building or scaling a pre-bill or concurrent review program from inception
Preferred: experience with pediatric, academic medical center, or specialty inpatient populations
Preferred: familiarity with AI-assisted coding or CDI technologies and governance
Preferred: Six Sigma, Lean, or PMP certification

Benefits

Comp & perks

Annual performance-based bonus
Comprehensive medical, dental, and vision coverage
401(k) with company match
Paid time off and holidays
Continuing education and certification maintenance support
Remote work arrangement
Flexibility to support client time zones and deadlines