About Us:
Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.
We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.
Essential Functions:
Lead offshore Clinical Audit and CDI operations, including DRG validation and clinical validation programs
Develop and implement scalable offshore operating models aligned with U.S. regulatory and payer standards
Establish governance, policies, and standard operating procedures consistent with ACDIS, AHIMA, CMS, and payer guidance
Drive continuous improvement in quality, productivity, and audit consistency
Oversee validation of high‑risk diagnoses (e.g., sepsis, AKI, acute respiratory failure, encephalopathy, malnutrition)
Ensure audit determinations are clinically valid, compliant, and defensible
Monitor and address over‑coding and under‑coding risks
Serve as the final escalation point for complex clinical validation issues
Lead large offshore teams, including clinical auditors, CDI specialists, managers, and supervisors
Support hiring, onboarding, training, and ongoing competency development
Maintain audit calibration, quality assurance, and peer review processes
Mentor leadership team members to build long‑term delivery capability
Partner closely with U.S. onshore Directors, VPs, and client leadership
Support onboarding and expansion of new client programs (e.g., large academic medical centers)
Participate in executive‑level discussions regarding audit outcomes, trends, and performance
Ensure offshore delivery aligns with client‑specific workflows and expectations
Ensure compliance with ICD‑10‑CM/PCS guidelines, Coding Clinic, and DRG logic
Monitor key performance indicators related to:
Audit accuracy and quality
Productivity and turnaround time
SOI/ROM impact
Financial and denial‑prevention outcomes
Deliver structured reporting and dashboards to onshore leadership
Clinical or coding credential: RN/MBBS/MD, CCS/CPC/RHIA/RHIT
8+ years experience in CDI, clinical auditing, DRG validation, or revenue integrity
3+ years in a senior leadership role (Senior Manager / Associate Director / Director)
Strong expertise in:
DRG validation and clinical validation
SOI/ROM
ICD‑10‑CM/PCS and Official Coding Guidelines
Payer audit and denial trends
Demonstrated experience leading off
PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
