Director, DRG Validation

At Zelis, we Get Stuff Done. So, let’s get to it! 

  

A Little About Us 

Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.

At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.

  

A Little About You 

You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are.

Position Overview

The Director, DRG Validation is responsible for the strategic leadership, operational performance, innovation, and growth of the DRG Validation solution across both pre-pay and post-pay payment integrity programs. This role serves as the enterprise leader for DRG Validation, accountable for product performance, operational execution, quality outcomes, client value realization, and future-state solution development.

The Director leads a global organization of coding, clinical, quality, and operational professionals across the United States and India, ensuring scalable delivery, operational excellence, and consistent client outcomes. This role partners closely with Product, Technology, Analytics, Operations, Sales, Client Management, and Clinical leadership to define and execute the long-term vision for DRG Validation.

As the senior subject matter expert for inpatient coding and reimbursement integrity, the Director is responsible for advancing innovation through automation, artificial intelligence, machine learning, and workflow transformation initiatives that improve coding accuracy, operational efficiency, scalability, and savings performance. This role translates industry changes, reimbursement trends, client needs, and market opportunities into strategic initiatives that strengthen the DRG Validation solution and support enterprise growth objectives.

What You'll Do:

• Own the strategic direction, growth, and performance of the DRG Validation solution across all clients and lines of business. 

• Accountable for achieving savings, revenue, and productivity targets for the solution. 

• Develop and execute multi-year plans that support organizational growth objectives, client value, operational scalability, and product innovation. 

• Establish, monitor, and report on key performance indicators (KPIs) and operational, financial, quality, and client performance metrics, utilizing data-driven insights to identify opportunities, mitigate risks, and drive achievement of strategic and operational goals.  

• Partner with executive leadership to identify market opportunities, growth initiatives, and competitive differentiation strategies. 

• Translate industry trends, reimbursement changes, coding updates, and regulatory developments into strategic business recommendations. 

• Own strategic direction and operational performance across both pre-pay and post-pay DRG Validation programs, ensuring alignment with client objectives, reimbursement integrity goals, and organizational growth strategies. 

 

Operational Leadership & Performance Management 

• Lead and develop managers, clinical leaders, coding professionals, and quality teams supporting the DRG Validation function. 

• Ensure operational excellence through effective resource planning, productivity management, quality oversight, and performance optimization. 

• Drive continuous improvem