Director CERIS DRG Audit Program

The Director, CERIS DRG Audit Program is a strategic and operational leader responsible for the development, implementation, and oversight of all DRG clinical validation and audit initiatives. This role ensures the integrity of healthcare payments through the identification and recovery of improper payments, optimization of DRG assignments, and continuous improvement of coding accuracy, clinical documentation, and regulatory compliance.

The Director leads teams of clinical and coding auditors while collaborating across operations, policy, technology, analytics, product, sales, and client-facing functions to drive organizational performance, quality outcomes, and business growth.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES

• Develop and execute the strategic vision for the DRG Audit Program, ensuring alignment with organizational objectives, regulatory requirements, industry standards, and emerging trends
• Provide leadership and oversight for all aspects of the DRG audit lifecycle, including clinical validation, coding validation, appeals, quality assurance, operational performance, and continuous process improvement
• Establish performance goals, quality standards, key performance indicators (KPIs), and service level agreements (SLAs), utilizing data-driven insights to optimize program effectiveness, savings outcomes, and business results
• Lead, develop, and mentor teams of clinical, coding, and readmission auditors while fostering a culture of accountability, collaboration, innovation, and professional growth
• Serve as the organization's subject matter expert for DRG validation, clinical documentation, coding compliance, reimbursement methodologies, audit escalation management, and regulatory requirements
• Partner with Operations, Policy, Product, Technology, Analytics, Sales, Client Services, and other stakeholders to improve processes, support product development, drive client success, and contribute to business growth initiatives
• Provide e