Revecore

1.001 – 5.000 Angajați

Revecore este o companie de recuperare a veniturilor din domeniul asistenței medicale, care ajută spitalele și sistemele de sănătate să identifice și să încaseze rambursări care altfel ar putea fi omise. Platforma ReClaim™ combină inteligența artificială proprietară, informațiile despre cereri, automatizarea fluxurilor de lucru și motoare de reguli pentru plătitori cu expertiză clinică, juridică și în domeniul rambursărilor. Platforma sprijină recuperarea cererilor complexe, inclusiv cereri VA, rezultate în urma accidentelor auto, cereri de despăgubire pentru accidente de muncă și cereri Medicaid, precum și gestionarea refuzurilor, recuperarea plăților insuficiente și accelerarea creanțelor. Infrastructura Revecore, conformă cu HIPAA și certificată SOC 2, utilizează modele de învățare automată antrenate pe sute de milioane de cereri, iar compania deservește peste 1.300 de spitale. Echipa sa reunește expertiză în tehnologia medicală, operațiuni ale ciclului veniturilor, servicii clinice, domeniul juridic și rambursări.

Locurile de muncă ale companiei

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.

acum 6 zile

Statele Unite ale Americii

Wisconsin Remote Normă întreagă Lider Limbă Obligatorie: engleză Director

Descriere

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

Cerințe

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

Beneficii

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