Director, DRG Services
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.
Responsibilities:
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.
Qualifications:
- 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:
- 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.
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