Director, DRG Servies

The Director of DRG Services is responsible for leading and executing the strategic vision and operational oversight of the DRG service line. This role involves driving growth, optimizing service delivery, and collaborating with internal and external stakeholders to ensure high-quality client outcomes. The director will oversee process improvement, performance metrics, and the implementation of innovative solutions to enhance the service line's impact and efficiency. 

Strategic Leadership:

- Collaborate with key internal stakeholders to   assist with the development and implementation of the strategic plan for the DRG and Denials (Coding and Clinical Validation) service lines.

- Align service line goals with the   organization's broader mission and growth objectives.

- Monitor industry trends and competitive   landscape to identify opportunities for service expansion and innovation.

Operational Management:

- Oversee day-to-day clinical operations for the DRG and Denials service lines,   ensuring efficient service delivery and adherence to quality standards.

- Manage resource allocation, budgeting, and financial performance for the service line.

- Assist with the development and   implementation of key performance indicators (KPIs) to assess operational   success and identify areas for improvement.

- Develop and update standard operating   procedures for DRG related workflows.

Client   and Stakeholder Engagement:

- Collaborate with Client Engagement and serve   as the DRG liaison with clients to foster strong relationships and understand   evolving client needs.

- Participate in new DRG client onboarding and   identify barriers that may impact go live.

- Collaborate with internal teams (e.g., sales,   marketing, IT) to ensure seamless service integration and client   satisfaction.

- Facilitate communication between clients and   internal teams to drive continuous service enhancements.

Team Development and   Leadership:

- Build and lead a high-performing team, providing mentorship and professional   development opportunities.

- Lead recruitment strategies for the CCA team and oversee onboarding of new team   members.

- Foster a culture of accountability, innovation, and continuous learning within the   service line.

- Conduct regular team performance reviews and implement strategies to enhance team   effectiveness.

Process   Improvement and Innovation:

- Identify opportunities to streamline   processes and enhance service delivery efficiency.

- Leverage data analytics to inform   decision-making and optimize service line performance.

- Drive the adoption of technology and   automation to improve accuracy and scalability.

Partnership   Reviews, Data Analysis & Reporting:

- Utilize data analytics and reporting to track   and report on DRG performance metrics for clients

- Participate and/or present dashboards to   clients, highlighting opportunities for improvement and showcasing results   from company's DRG reviews.

- Analyze client denial trends and develop   tailored action plans to address root causes and improve DRG-related appeals   success rates.

- Provide guidance on denial management   strategies, including proactive measures and appeal processes, to maximize   revenue recovery.

Business   Development & Marketing Support:

- Collaborate with the sales and business   development teams to identify new opportunities and support proposal   development for DRG services.

- Participate in client pitches, presenting the   value of DRG optimization services and showcasing successful case studies.

- Collaborate with marketing team to create or   update marketing collateral for DRG services.

- Attend conferences, i.e., ACDIS, AHIMA,   networking with existing clients and supporting the business development team   with new opportunities.

- Strong leadership, interpersonal, analytical, project management and presentation skills. Excellent   written and verbal communication skills. 

- Minimum of 5 years of experience in DRG services, healthcare operations, or related areas.

- Proven track record in strategic planning, operational leadership, and team management.

- Strong analytical skills with the ability to translate data into actionable insights.

- Excellent communication and interpersonal skills.

- Experience working with healthcare providers, payers, or vendors.

- Knowledge of healthcare regulations, DRG methodologies, and reimbursement practices.

- Prior consulting experience in healthcare or revenue integrity is highly preferred.

- Knowledge of DRG methodologies, coding standards (ICD-10, CPT), revenue cycle operations, and   CMS regulations.

- Exceptional communication  and interpersonal skills, with the ability to engage effectively with both   clinical and administrative stakeholders.

- Proven leadership and project management skills, with the ability to manage multiple client   engagements simultaneously.

- Strong problem-solving and critical-thinking abilities with a focus on delivering results.

- Experience using Outlook, Excel, PowerPoint, and Visio. 

WORK EXPERIENCE, EDUCATION   AND CERTIFICATIONS: List preferred/required   work experience, education, and certifications.

- Bachelor’s degree in Health   Information Management, Nursing, Healthcare Administration, or a related   field required.

- Master’s degree in   Healthcare Administration, Business Administration, or a related field   preferred.

- Certified Coding Specialist   (CCS), Certified Documentation Improvement Practitioner (CDIP), or Registered   Health Information Administrator (RHIA) preferred.

 WORKING CONDITIONS AND   PHYSICAL REQUIREMENTS: List physical demands and   usual work conditions.

Conditions typically associated with an office environment. While performing the essential duties and   responsibilities, the employee is regularly required to talk or hear. May be   frequently required to sit, stand, or walk. Moderate to prolonged reading,   typing, and computer work. Ability to perform tasks involving physical   activity that may include lifting up to 50 pounds. Subject to exposure to all   environmental hazards associated with healthcare and office work. 

- Limited Travel required: up to 25% as needed

Must be   able to work in a fast-paced, dynamic consulting environment with shifting   priorities.