DRG Business Solutions Lead (AI)

TL;DR

DRG Business Solutions Lead (AI): Translating clinical-coding domain expertise into scalable product capabilities for healthcare payment integrity with an accent on audit logic, prompt engineering, and AI model validation. Focus on building trustworthy AI-driven audit workflows by partnering with product, engineering, and clinical leadership to define requirements and ensure defensibility.

Location: Must be based in the United States

Company

hirify.global is a healthcare data platform company backed by $100M in funding, focused on making healthcare data usable for health plans to improve outcomes and reduce waste.

What you will do

• Define product requirements, audit methodologies, and business logic for scalable audit workflows.
• Translate complex coding guidelines and DRG definitions into structured, codifiable audit logic.
• Partner with data science to define clinical entity extraction targets for NLP pipelines.
• Develop and maintain the DRG audit prompt library and validation criteria.
• Test and review AI model outputs, flagging false positives and negatives to drive refinement.
• Represent the voice of the customer in product demonstrations and client discovery sessions.

Requirements

• Must be based in the United States
• RN with 7+ years of progressive DRG audit experience in a payer or vendor space.
• Active coding credential: CCS, CIC, RHIA, or RHIT.
• Deep mastery of ICD-10-CM/PCS, AHA Coding Clinic, and CMS POA Reporting Guidelines.
• Demonstrated experience in payer-side or vendor-side DRG coding validation audits.
• Proven ability to defend or overturn DRG findings on appeal.

Nice to have

• Experience partnering with Product, Engineering, or AI/ML teams.
• Familiarity with prompt engineering, generative AI, and clinical document extraction.
• Experience translating clinical requirements into user stories or product specifications.
• Background in high-growth healthcare technology or startup environments.

Culture & Benefits

• Unlimited paid time off policy.
• Comprehensive health coverage with multiple plan options.
• Equity grants for every employee.
• Home office setup allowance and monthly cell phone stipend.
• Growth-focused environment with support for professional development.