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Niche DRG coding and RN credential reduces candidate pool despite remote.
Deep U.S. DRG, payer and coding expertise limits transferability across industries.
Explicit 7+ years, RN requirement and mandatory coding certification create rigid screening filters.
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Own the translation of DRG audit expertise into scalable, codifiable product capabilities defining audit logic and prompt libraries.
Collaborate with product, AI engineering, and clinical leadership to validate AI outputs and maintain defensibility standards for audit findings.
Partner with data science on NLP model development and represent DRG subject matter expertise throughout product lifecycle including client engagements.
RN with 7+ years of progressive DRG audit experience in payer or vendor environment.
Active coding credential required: CCS, CIC, RHIA, or RHIT.
Deep mastery of ICD-10-CM/PCS Official Coding Guidelines, AHA Coding Clinic, MS/APR-DRG Definitions Manual, and CMS POA Reporting Guidelines.
Experience with payer-side or vendor-side DRG audit, including defending or overturning DRG appeals.
Proven ability to define and translate complex clinical coding and audit rules into structured business/product requirements.
Experience working closely with Product Management, Engineering, and Data Science teams to develop AI-driven healthcare technology solutions.
Comfortable operating in remote, high-growth, product-focused environments working US Eastern time zone hours.