California Licensed DRG Validation Director

Job Summary

A company is looking for a DRG Clinical Validation Director.

Key Responsibilities

• Develop and manage DRG clinical validation solutions, including MS and APR-DRG validation
• Lead the DRG Clinical Validation team and oversee the clinical claims review process
• Collaborate with various teams to support client implementations and monitor emerging trends in payment integrity

Required Qualifications

• Bachelor's degree in health administration, business, or nursing
• 5+ years of experience in healthcare billing and coding
• 3+ years of experience in claims auditing and recovery auditing
• Nursing license and certifications of CCDS or CDIP required
• Previous supervisory experience is necessary