VP, DRG Validation

Who We Are 
 

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify’s AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We’re reshaping healthcare payment through seamless intelligence. 

Location: This role is fully remote.

About the Opportunity 

The Vice President of DRG Validation is a cross-functional leader responsible for the strategic direction, development, and execution of comprehensive DRG (Diagnosis-Related Group) validation programs across MS-DRG, APR-DRG, and AP-DRG methodologies. This individual combines clinical expertise, operational oversight, and technical acumen to lead end-to-end delivery—from solution design and implementation to production performance, client support, and innovation initiatives. The role requires a visionary and hands-on leader who thrives in complex, high-growth environments and excels at aligning teams, technology, and strategy to drive outcomes in healthcare reimbursement and payment integrity. 

What you’ll do 

Strategic Leadership

• Develop and execute a multi-platform production strategy for DRG validation services.
• Align organizational goals with evolving regulatory requirements, payer expectations, and client needs.
• Lead cross-functional teams to optimize workflows, automation, and platform interoperability.

Operational Oversight

• Manage end-to-end production processes across multiple technology platforms, ensuring scalability and efficiency.
• Manage daily workflow, resource allocation, productivity targets, and SLA adherence across multiple platforms.
• Coordinate queue management, scheduling, capacity planning, and escalations to ensure smooth, timely execution.
• Establish and monitor KPIs for productivity, accuracy, turnaround time, and client satisfaction.

Team Leadership & Development

• Supervise a multidisciplinary team of clinical auditors, coders, and team leads, providing coaching, mentorship, and development plans.
• Foster a high-performance culture focused on accountability, innovation, and clinical excellence.
• Drive change management initiatives and lead process improvements to increase efficiency and quality

Quality & Compliance

• Ensure adherence to CMS guidelines, ICD-10-CM/PCS coding standards, and payer-specific policies.
• Lead internal audits and quality assurance programs to maintain high standards of clinical and coding accuracy.
• Collaborate with Compliance and Legal teams to mitigate risk and ensure regulatory alignment.

Technology & Innovation

• Partner with Product and Engineering teams to enhance platform capabilities and user experience.
• Drive adoption of AI, NLP, and automation tools to improve coding efficiency and clinical validation accuracy.
• Evaluate emerging technologies and recommend strategic investments.

Client & Stakeholder Engagement

• Serve as a senior point of contact for internal and external clients, providing strategic insights and operational transparency.
• Present performance metrics and strategic updates to executive leadership

• Education: Bachelor’s degree in Nursing, Health Information Management, or related field required; Master’s preferred.
• Licensure/Certifications: Active RN license required. CCDS, CDIP, CCS, RHIA, or RHIT strongly preferred.
• 5+ years of experience in clinical coding, DRG validation, or health information management.
• 5+ years in executive leadership roles with multi-platform or multi-site operational oversight.
• Deep understanding of DRG methodologies, coding guidelines, and healthcare reimbursement, focused on recovery strategy.
• Proven success managing clinical teams and implementing scalable solutions in a remote work environment.
• Experience with technology platforms used