Partnering with product and engineering teams, the full-time remote State Licensed DRG Solutions Lead will define product requirements, translate clinical coding guidelines into audit logic, and validate AI outputs to enhance healthcare payment integrity solutions. Key responsibilities Define product requirements and audit methodologies to support scalable audit workflows Translate clinical coding guidelines into structured audit logic and maintain the DRG audit prompt library Collaborate with data science to refine NLP models and ensure client needs are reflected in product design Required qualifications Registered Nurse (RN) with 7+ years of DRG audit experience in a payer or vendor environment Active coding credential: CCS, CIC, RHIA, or RHIT Deep knowledge of U.S. healthcare payer payment integrity programs and audit strategies Mastery of ICD-10-CM/PCS coding guidelines and CMS POA Reporting Guidelines Experience defending or overturning DRG findings on appeal