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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates deep expertise in Diagnosis-Related Group Validation (DRGV) and MS-DRG methodology, with a strong focus on revenue integrity and coding practices. Capable of leading cross-functional initiatives and driving execution across technical, operational, and commercial teams while leveraging AI and automation for enhanced service delivery.
Highest-signal resume keywords
Diagnosis-Related Group Validation (DRGV)Medicare Severity Diagnosis-Related Group (MS-DRG)Revenue IntegrityAI and Automation in DRGVCross-Functional Leadership
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Coding ExperienceClinical Documentation Integrity (CDI)Complex Coding TablesPayer Contract InterpretationReimbursement Methodology
Soft Skills
Strong CommunicationClient-Facing Skills
Tools & Technologies
Data SolutionsScalable Technology Solutions
Industry Keywords
Healthcare Revenue CyclePayment IntegrityCharge CaptureClaims AdjudicationDiagnosis-Related Group Downgrades (DRGD)
About the role
Key responsibilities & impact- Lead the development and launch of Revecore’s DRGV service offering
- Define the operating model, workflows, staffing requirements, productivity metrics, quality standards, and industry benchmarks
- Provide subject matter expertise in DRGV, coding, MS-DRG methodology, revenue integrity, and claims
- Partner with Product, Data, AI, Development, and Operations teams on scalable processes and technology solutions
- Identify opportunities to use AI and automation for account selection, prioritization, processing, productivity, and service delivery
- Serve as the technical and operational liaison between DRGV subject matter experts and Product and Engineering teams
- Support software development and complex code-table requirements
- Establish performance expectations and metrics and monitor implementation, operational, and financial goals
- Advise on pricing models, marketing strategy, positioning, and sales enablement
- Support client-facing sales efforts during prospect and client discussions
- Partner with the BCO team delivering services to clients
- Drive execution across a matrixed organization and build alignment around the new solution
Requirements
What you’ll need- Deep expertise in Diagnosis-Related Group Validation (DRGV), grounded in hands-on coding experience
- 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
- Experience developing and maintaining complex coding or reimbursement code tables
- Experience partnering with Product, Engineering, or software development teams to translate requirements into scalable technology solutions
- Understanding of data, artificial intelligence (AI), and automation applied to DRGV
- Ability to lead cross-functional initiatives and drive execution across technical, operational, and commercial teams
- Strong communication and client-facing skills
- Preferred: Experience with Diagnosis-Related Group Downgrades (DRGD)
- Preferred: Experience within a vendor-side DRGV, payment integrity, revenue integrity, or healthcare revenue cycle organization
- Preferred: Experience launching or scaling a healthcare service line, product, or operational capability
- Preferred: Experience supporting client-facing solutioning, sales enablement, or industry thought leadership
- Must reside in the United States in one of the listed states
- Eligibility to work in the United States
- Successful completion of a background check
Benefits
Comp & perks- Remote work from home
- Quiet, distraction-free home work environment
- Secure internet connection
- Home internet speeds greater than 20 Mbps download and 10 Mbps upload
- Workspace accommodating workstation equipment and related materials
- Affirmative Action/Equal Opportunity Employer
- Interview recording/transcription alternatives available upon request