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Revecore
Revecore
1,001 – 5,000 Employees
B2BHealthcareSaaS
Revecore is a healthcare revenue recovery company helping hospitals and health systems find and collect reimbursement that may otherwise be missed. Its ReClaim™ platform combines proprietary AI, claims intelligence, workflow automation, and payor rule engines with clinical, legal, and reimbursement expertise. The platform supports complex claim recovery, including VA, auto accident, workers’ compensation, and Medicaid claims, alongside denials management, underpayment recovery, and accounts receivable acceleration. Revecore’s HIPAA-compliant, SOC 2-certified infrastructure uses machine-learning models trained on hundreds of millions of claims, and the company serves more than 1,300 hospitals. Its team spans healthcare technology, revenue cycle operations, clinical services, legal expertise, and reimbursement.
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Director of Diagnosis-Related Group Validation (DRGV)

Lead the launch of Revecore’s Diagnosis-Related Group Validation service for hospitals seeking to recover earned revenue. Shape its operating model, technology, staffing, performance measures, pricing, and go-to-market approach.

USUnited StatesALAlabamaCTConnecticutFLFloridaIAIowaKSKansasKYKentuckyLALouisianaMEMaineMAMassachusettsMIMichiganMNMinnesotaMSMississippiMOMissouriNENebraskaNHNew HampshireNCNorth CarolinaOHOhioOKOklahomaPAPennsylvaniaRIRhode IslandSCSouth CarolinaSDSouth DakotaTNTennesseeTXTexasVTVermontVAVirginiaWVWest VirginiaWIWisconsinRemoteFull-timeLeadEnglish RequiredDirector

Description

  • Lead Revecore’s Diagnosis-Related Group Validation service launch and development
  • Establish the operating model, workflows, staffing plan, productivity measures, quality standards, and industry benchmarks
  • Serve as a DRGV, coding, MS-DRG, revenue integrity, and claims subject matter expert
  • Collaborate with Product, Data, AI, Development, and Operations teams to create scalable processes and technology solutions
  • Assess how AI and automation can improve account selection, prioritization, processing, productivity, and service delivery
  • Act as the technical and operational bridge between DRGV specialists and Product and Engineering teams
  • Contribute to software development and address complex coding-table requirements
  • Set performance expectations and metrics while tracking implementation, operational, and financial objectives
  • Provide guidance on pricing, marketing strategy, market positioning, and sales enablement
  • Participate in prospect and client conversations to support sales efforts
  • Work with the BCO team responsible for client service delivery
  • Coordinate execution across a matrixed organization and align stakeholders around the new solution

Requirements

  • Extensive Diagnosis-Related Group Validation expertise supported by hands-on coding experience
  • Expert knowledge of Medicare Severity Diagnosis-Related Group classification and reimbursement methodology
  • Strong knowledge of revenue cycle and revenue integrity, including charge capture, charging patterns, coding, and Clinical Documentation Integrity
  • Experience interpreting payer contracts, reimbursement provisions, and claim adjudication processes
  • Experience designing, leading, or making significant contributions to DRGV programs
  • Experience creating and maintaining complex coding or reimbursement code tables
  • Experience working with Product, Engineering, or software development teams to convert requirements into scalable technology solutions
  • Working knowledge of data, artificial intelligence, and automation applications in DRGV
  • Ability to lead cross-functional initiatives across technical, operational, and commercial teams
  • Strong communication and client engagement abilities
  • Preferred: Experience with Diagnosis-Related Group Downgrades
  • Preferred: Experience at a vendor-side DRGV, payment integrity, revenue integrity, or healthcare revenue cycle organization
  • Preferred: Experience launching or expanding a healthcare service line, product, or operational capability
  • Preferred: Experience with client solutioning, sales enablement, or healthcare industry thought leadership
  • Must live in the United States in one of the specified states
  • Authorization to work in the United States
  • Successful completion of a background check

Benefits

  • Work remotely from home
  • A quiet, distraction-free home office environment
  • A secure internet connection
  • Home internet service exceeding 20 Mbps download and 10 Mbps upload speeds
  • Workspace suitable for company-provided workstation equipment and related materials
  • Affirmative Action/Equal Opportunity Employer
  • Interview recording and transcription alternatives available upon request

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