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 in clinical coding and validation (e.g., 3M, Optum, proprietary systems).
• Strong analytical, communication, and strategic planning skills.

Preferred Attributes:

• Visionary yet detail-oriented; can zoom out to see big picture while executing tactical tasks.
• Strong analytical thinker with expertise in data interpretation and analysis
• Ability to thrive in fast paced environment.
• Organized and able to execute on tight deadlines.
• Technically savvy with ability to quickly problem solve and identify anomalies in data or processes.
• Collaborative mindset with the ability to influence across departments.
• Data-driven decision-maker with a focus on outcomes and impact.
• Comfortable leading in fast-paced, ambiguous, and high-growth environments

What Success Looks Like...

After 3 months

• You will have a strong understanding of the role.
• You begin building relationships and collaborating with peers.
• You develop effective time and priorities management.
• You receive initial feedback about your performance and are using it to improve.
• You've gained confidence in your abilities and are starting to feel more comfortable in your role.

After 1 year

• You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency.
• You have established a strong network of internal relationships and are recognized as a key collaborator.
• You've been entrusted with greater responsibility indicating the company's confidence in your abilities.
• You see opportunities for career progression and personal development.

Pay range: $200,000 - $230,000 USD

This is an exempt position. The salary range is for Base Salary.Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee's geographic location.

What's in it for you

• PTO, Paid Holidays, and Volunteer Days

• Eligibility for health, vision and dental coverage, 401(k) plan participation

with company match, and flexible spending accounts

• Tuition Reimbursement

• Eligibility for company-paid benefits including life insurance, short-term

disability, and parental leave.

• Remote and hybrid work options

What values we'll share with you

• Ask why

• Think big

• Be humble

• Optimize for customer impact

• Deliver results

At Machinify, we're reimagining a simpler way forward. This begins with our employees. We are innovators who value integrity, teamwork, accuracy, and flexibility. We do the right thing, and we listen to the needs of our clients and their members. As tenured experts with unmatched experience, we champion diverse perspectives that help us to better understand and serve our clients.

Our values come to life through our culture. We embrace flexible working arrangements that allow our employees to bring innovation to life in the way that best suits their productivity. We work cross-functionally, abandoning silos, to bring innovative and accurate solutions to market. We invest in each other through ongoing education and team celebrations, and we give back to our communities through dedicating days for volunteering. Together, Machinify is making healthcare work better for everyone, and we're passionate about a future with better outcomes for all.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please contact our People Operations team atmachinify_careers@machinify.com. See our Candidate Privacy Notice at:https://www.machinify.com/candidate-privacy-notice/