Zelis
Director, DRG Validation
US FL St · Director
Sponsorship not specifiedDetected 22 days ago
Machine LearningComplianceAccessibilityPerformance ManagementHIPAALeadershipCollaborationPublic Speaking
About the role
- At Zelis, AI is woven into the fabric of how we work.
- 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.
Responsibilities
- Own the strategic direction, growth, and performance of the DRG Validation solution across all clients and lines of business.
- 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.
- Lead and develop managers, clinical leaders, coding professionals, and quality teams supporting the DRG Validation function.
- Drive continuous improvement initiatives that improve accuracy, turnaround times, savings capture, and client outcomes.
- Establish governance processes, operational standards, and scalable workflows to support business growth.
- Lead and develop a globally distributed team across the United States and India, ensuring effective workforce planning, operational consistency, talent development, and scalability.
- Establish organizational structures, succession planning, and performance frameworks that support continued business growth and global delivery strategies.
- Partner with Product leadership and Technology teams to define future-state platform capabilities and prioritize investments that improve scalability, quality, operational efficiency, and client value.
Requirements
- Current inpatient coding certification required (CCS, CIC, RHIA, RHIT, or equivalent).
- 5+ years of progressive leadership experience leading managers, supervisors, or large operational teams.
- A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication.
Nice to have
- Active Registered Nurse (RN) licensure preferred.
- Experience leading global teams.
- Experience with pre-pay and post-pay payment integrity programs.
Benefits
- 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.
- 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.
- 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.
Company info
- At Zelis, we Get Stuff Done.
- A Little About Us
Equal opportunity
- Zelis is proud to be an equal opportunity employer.
- All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
- We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role.
- We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.
Visa & Work Authorization
- Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.
This listing is sourced directly from Zelis's careers page and normalized into a canonical job model.