VP, DRG Validation
Employment Information
Job Description
Vice President of DRG Validation leading healthcare data solutions at Machinify. Directing DRG validation programs and managing cross-functional teams in a remote environment.
Responsibilities:
- Develop and execute a multi-platform production strategy for DRG validation services.
- Align organizational goals with evolving regulatory requirements, payer expectations, and client needs.
- Lead cross-functional teams to optimize workflows, automation, and platform interoperability.
- Manage end-to-end production processes across multiple technology platforms, ensuring scalability and efficiency.
- Manage daily workflow, resource allocation, productivity targets, and SLA adherence across multiple platforms.
- Coordinate queue management, scheduling, capacity planning, and escalations to ensure smooth, timely execution.
- Establish and monitor KPIs for productivity, accuracy, turnaround time, and client satisfaction.
- Supervise a multidisciplinary team of clinical auditors, coders, and team leads, providing coaching, mentorship, and development plans.
- Ensure adherence to CMS guidelines, ICD-10-CM/PCS coding standards, and payer-specific policies.
- Serve as a senior point of contact for internal and external clients, providing strategic insights and operational transparency.
Requirements:
- Bachelor’s degree in Nursing, Health Information Management, or related field required; Master’s preferred.
- Active RN license required.
- CCDS, CDIP, CCS, RHIA, or RHIT strongly preferred.
- 5+ years of experience in clinical coding, DRG validation, or health information management.
- 5+ years in executive leadership roles with multi-platform or multi-site operational oversight.
- Deep understanding of DRG methodologies, coding guidelines, and healthcare reimbursement, focused on recovery strategy.
- Proven success managing clinical teams and implementing scalable solutions in a remote work environment.
- Experience with technology platforms used in clinical coding and validation (e.g., 3M, Optum, proprietary systems).
- Strong analytical, communication, and strategic planning skills.
Benefits:
- PTO
- Paid Holidays
- Volunteer Days
- Eligibility for health, vision and dental coverage
- 401(k) plan participation with company match
- Flexible spending accounts
- Tuition Reimbursement
- Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
- Remote and hybrid work options
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