[Hiring] Clinical Director, Revenue Integrity & DRG Validation @CorroHealth

Role Description

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

• 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.
• 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.
• 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.
• 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.
• 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.

Qualifications

• 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.
• Coding certification: CCS (AHIMA) Preferred.
• CDI certification: CCDS (ACDIS) or CDIP (AHIMA) required.

Requirements

• Minimum five (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 three (3) years of people management experience leading clinical, coding, or CDI teams, including direct supervision of managers or team leads.
• Demonstrated experience managing programs in a hospital, health system, payer, or healthcare consulting/outsourcing environment.
• Proven track record of delivering measurable financial and quality outcomes through DRG validation or CDI programs.

Knowledge, Skills, and Abilities

• Expert command of ICD-10-CM/PCS, MS-DRG and APR-DRG grouping logic, CC/MCC capture, SOI/ROM, and Coding Clinic guidance.
• Deep understanding of compliant query practice, clinical validation standards, and payer denial and appeal processes.
• Strong analytical skills with the ability to interpret program data and present findings to executive and clinical audiences.
• Executive presence, exceptional written and verbal communication, and the ability to influence physicians, HIM, and finance leaders.
• Proficiency with encoders, CDI platforms, and EHR systems (e.g., 3M/Solventum, Epic, Cerner/Oracle Health).

Preferred Qualifications

• Experience in a multi-client outsourced services or consulting environment.
• Prior experience building or scaling a pre-bill or concurrent review program from inception.
• Experience with pediatric, academic medical center, or specialty inpatient populations.
• Familiarity with AI-assisted coding or CDI technologies and their governance.
• Six Sigma, Lean, or PMP certification.

Working Conditions

• Remote position with an estimated 15–25% travel for client meetings, on-site assessments, and company events.
• Standard business hours with flexibility required to support client time zones and deadlines.
• Extended periods of computer-based work.

Compensation and Benefits

• Competitive base salary commensurate with experience, plus annual performance-based bonus.
• Comprehensive medical, dental, and vision coverage; 401(k) with company match; paid time off and holidays; continuing education and certification maintenance support.