DRG (Diagnosis-Related Group) Business Solutions Lead

About the Role:

• The DRG Business Solutions Lead is the clinical-coding domain authority partnering with product, AI, and clinical leadership.
• This role translates DRG audit expertise into product capability, defining audit logic and shaping prompt libraries.
• It is a builder seat for a DRG expert to encode knowledge into a scalable product.

Day-to-Day Responsibilities:

• Define product requirements, audit methodologies, and business logic for accurate audit workflows.
• Translate official coding guidelines into structured, codifiable audit logic.
• Map audit signal to data domains, evidence requirements, and citation frameworks.

AI/NLP Model Partnership:

• Partner with data science to define clinical entity extraction targets for NLP pipeline.
• Test and review model outputs, flag false positives/negatives, and drive model refinement.
• Develop edit specifications, assumptions, and validation criteria.

Client Engagement:

• Participate in client discovery sessions, product demos, and advisory discussions as a subject matter expert.
• Represent customer voice throughout product lifecycle.
• Develop test scenarios and validation criteria for new audit capabilities.