Abacus Insights
DRG (Diagnosis-Related Group) Business Solutions Lead
Remote US
Sponsorship not specifiedDetected 14 hours ago
AzureDevOpsMachine LearningData ScienceNLPLLMsProduct ManagementProduct StrategyJiraConfluenceVendor ManagementICD-10LeadershipCommunicationCollaborationAdaptability
About the role
- This is not a traditional auditor seat - this is a builder seat.
- Translate Official Coding Guidelines, AHA Coding Clinic, MS/APR-DRG Definitions Manual, and CMS POA Reporting Guidelines into structured, codifiable audit logic.
- Participate in client discovery sessions, product demonstrations, solution reviews, and customer advisory discussions as a DRG and payment integrity subject matter expert.
Responsibilities
- Define product requirements, audit methodologies, and business logic to support accurate, scalable audit workflows.
- Define and maintain the DRG audit prompt library (principal dx, CC/MCC, PCS, POA, discharge disposition, transfer DRG, mechanical ventilation, late-entry integrity).
- Test and review model outputs, flag false positives and negatives, and drive model refinement loops.
- Develop edit specifications, assumptions and validation criteria.
- Represent the voice of the customer throughout the product lifecycle, ensuring client needs, operational realities, and market demands are reflected in product design and roadmap decisions.
- Develop test scenarios, expected outcomes, and validation criteria for new audit capabilities and AI-driven features.
- Therefore, we dedicate resources to building diverse teams and providing equal employment opportunities to all applicants.
- At the heart of who we are is a commitment to continuously and intentionally building an inclusive culture-one that empowers every team member across the globe to do their best work and bring their authentic selves.
- We carry that same commitment into our hiring process, aiming to create an interview experience where you feel comfortable and confident showcasing your strengths.
- If there's anything we can do to support that-big or small-please let us know.
Requirements
- Clear written and verbal communication. ability to translate technical coding rules into product requirements, finding letters, and executive narratives.
- Familiarity with payer contract language - readmission policies, audit rights, lookback window.
- Experience translating clinical or coding requirements into business requirements, user stories, or product specifications.
- Experience supporting client implementations, product demonstrations, training programs, or customer-facing engagements.
- Familiarity with Jira, Confluence, Azure DevOps, or similar product development and agile collaboration tools.
Skills
- Map audit signal to its data domain, evidence requirements, and citation framework.
Compensation
- Compensation for this role is based on experience, skills, and location, and includes base salary plus eligibility for performance bonuses and equity grants.
Benefits
- Partner with product management on product vision, roadmap prioritization across coding validation, clinical validation, IBR, observation, and readmission wedges.
- Partner with data science to define the clinical entity extraction targets the NLP pipeline must capture from parsed medical records.
- Utilize internal AI-enabled tools to quickly create prototypes, visualize workflows, and showcase product functionality, enabling effective communication of product vision and business value.
Company info
- Abacus Insights is transforming how data works for health plans. Our mission is simple: make healthcare data usable, so the people responsible for care and cost decisions can act faster, with confidence.
- We help health plans break down data silos to create a single, trusted data foundation. That foundation powers better decisions-so plans can improve outcomes, reduce waste, and deliver better experiences for members and providers alike. Backed by $100M from top investors, we're tackling big challenges in an industry that's ready for change. Our platform enables GenAI use cases by delivering clean, connected, and reliable healthcare data to support automation, prioritization, and decision workflows-and it's why we are leading the way.
- Our innovation begins with people. We are bold, curious, and collaborative-because the best ideas come from working together. We embrace the thoughtful use of AI and automation to drive innovation and efficiency, and we look for individuals who are curious and adaptable-those excited to leverage emerging technologies to enhance how we work-while keeping human insight, connection, and our clients at the center of every decision.
- Ready to make an impact? Join us and let's build the future together.
- Abacus Insights is transforming how data works for health plans.
- Our mission is simple: make healthcare data usable, so the people responsible for care and cost decisions can act faster, with confidence.
- We help health plans break down data silos to create a single, trusted data foundation.
- That foundation powers better decisions-so plans can improve outcomes, reduce waste, and deliver better experiences for members and providers alike.
- Backed by $100M from top investors, we're tackling big challenges in an industry that's ready for change.
- Our platform enables GenAI use cases by delivering clean, connected, and reliable healthcare data to support automation, prioritization, and decision workflows-and it's why we are leading the way.
- Our innovation begins with people.
- We are bold, curious, and collaborative-because the best ideas come from working together.
- We embrace the thoughtful use of AI and automation to drive innovation and efficiency, and we look for individuals who are curious and adaptable-those excited to leverage emerging technologies to enhance how we work-while keeping human insight, connection, and our clients at the center of every decision.
- Ready to make an impact?
- Join us and let's build the future together.
- make healthcare data usable, so the people responsible for care and cost decisions can act faster, with confidence.
Equal opportunity
- Our Commitment as an Equal Opportunity Employer
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This listing is sourced directly from Abacus Insights's careers page and normalized into a canonical job model.