Director, Pre-bill DRG Validation Program

About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.  We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.   JOB SUMMARY: The Director will develop and implement CDI strategies, policies, and workflows to optimize documentation processes and improve clinical outcomes and data integrity. Key responsibilities include growing the business and defining the market strategy as well as overseeing a team of CDI professionals and ensuring high-quality service delivery supporting multiple clients and systems. The Director plays a critical role in supporting client relationships, performance reporting, and the growth of CDI service lines. This is a remote position that may require up to 30% travel. ESSENTIAL DUTIES AND RESPONSIBILITIES:  Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member. Position Summary CorroHealth is seeking an accomplished clinical and coding leader to serve as Director of the Pre-bill DRG Validation Program. This role owns the strategy, operations, quality, and financial performance of CorroHealth's pre-bill DRG validation service line, which reviews inpatient encounters prior to claim submission to ensure that assigned MS-DRGs and APR-DRGs are fully supported by clinical documentation, accurately coded, and compliant with CMS, Official Coding Guidelines, and payer requirements. The Director leads a multidisciplinary team of clinical validation reviewers, coding auditors, and CDI specialists; partners with client hospital and health system leadership; and is accountable for program outcomes including accuracy rates, turnaround times, denial prevention, and net revenue impact. Key Responsibilities Program Leadership and Strategy Own end-to-end design, execution, and continuous improvement of the pre-bill DRG validation program across all assigned client engagements. Establish program goals, key performance indicators, and service-level commitments; report performance to executive leadership and clients. Develop and maintain review methodologies, case selection logic, and prioritization criteria that maximize financial and compliance impact. Identify opportunities to expand service offerings and support business development through subject-matter expertise, proposal input, and client presentations. Clinical and Coding Oversight Serve as the senior clinical and coding authority for DRG validation, clinical validation, and query practice within the program. Ensure all reviews are conducted in accordance with ICD-10-CM/PCS Official Guidelines for Coding and Reporting, AHA Coding Clinic, CMS regulations, ACDIS/AHIMA query practice guidelines, and applicable payer policies. Adjudicate escalated and complex cases, including clinical validation disputes, conflicting documentation, and high-dollar DRG shifts. Maintain a formal quality assurance program with inter-rater reliability targets, second-level review, and documented corrective action. Team Management Recruit, onboard, develop, and retain a high-performing team of clinical validators, DRG auditors, and CDI professionals, including team leaders and supervisors. Set productivity and quality expectations; conduct performance evaluations; manage coaching, development plans, and corrective action. Design and deliver ongoing education on regulatory changes, coding updates, and emerging clinical validation topics. Manage staffing models, capacity planning, and workload distribution to meet client volume and turnaround requirements. Client Relationship Management Act as executive point of contact for client HIM, CDI, Compliance, and Revenue Cycle leadership on program matters. Lead client governance meetings, present outcomes and trend analyses, and translate findings into actionable documentation and coding improvement recommendations. Resolve client escalations and manage program changes, scope adjustments, and issue remediation. Compliance, Data, and Operations Ensure program practices comply with HIPAA, OIG guidance, and CorroHealth compliance policies; support internal and external audits. Partner with Analytics to develop dashboards and reporting on DRG change rates, financial impact, query response rates, denial trends, and reviewer performance. Collaborate with Technology and Product teams on workflow tooling, case routing, and automation opportunities. Manage program budget, including labor costs, vendor relationships, and profitability targets. Required Qualifications Education Clinical degree required: 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. Certifications (all required) Coding certification: CCS (AHIMA) Preferred CDI certification: CCDS (ACDIS) or CDIP (AHIMA) required. Experience Minimum ten (5) 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 five (3) years of people management experience leading clinical, coding, or CDI teams, including direc