VP, DRG Validation

Vice President of Drg Validation

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.

This role is fully remote.

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 deliveryfrom 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 Youll Do

• 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

Team Leadership & Development

Quality & Compliance

Technology & Innovation

Client & Stakeholder Engagement

Qualifications

Education : Bachelors degree in Nursing, Health Information Management, or related field required; Masters 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 :

What Success Looks Like

After 3 months

After 1 year

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.

Whats in it for you

What values well share with you

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