DRG (Diagnosis-Related Group) Business Solutions Lead

About the Role

The DRG Business Solutions Lead is the clinical-coding domain authority who will partner directly with product, AI engineering, and clinical leadership to translate DRG audit expertise into product capability. This is not a traditional auditor seat — this is a builder seat.

You'll sit at the center of how Abacus builds trustworthy AI for healthcare payment integrity — defining the audit logic, shaping the prompt libraries, validating AI outputs, and owning the defensibility standard that every Abacus finding must meet. It's a rare seat for a DRG expert: instead of applying your coding and appeal-defense expertise one claim at a time, you'll encode it into a product used at scale, working shoulder-to-shoulder with product, engineering, and clinical leadership to shape how the next generation of audit technology gets built.

Your day to day

• Define product requirements, audit methodologies, and business logic to support accurate, scalable audit workflows.
• Translate Official Coding Guidelines, AHA Coding Clinic, MS/APR-DRG Definitions Manual, and CMS POA Reporting Guidelines into structured, codifiable audit logic.
• Define and maintain the DRG audit prompt library (principal dx, CC/MCC, PCS, POA, discharge disposition, transfer DRG, mechanical ventilation, late-entry integrity).
• Map audit signal to its data domain, evidence requirements, and citation framework.
• Partner with product management on product vision, roadmap prioritization across coding validation, clinical validation, IBR, observation, and readmission wedges.

AI / NLP Model Partnership

• Partner with data science to define the clinical entity extraction targets the NLP pipeline must capture from parsed medical records.
• Test and review model outputs, flag false positives and negatives, and drive model refinement loops.
• Develop edit specifications, assumptions and validation criteria.
• Participate in client discovery sessions, product demonstrations, solution reviews, and customer advisory discussions as a DRG and payment integrity subject matter expert.
• Represent the voice of the customer throughout the product lifecycle, ensuring client needs, operational realities, and market demands are reflected in product design.