DRG (Diagnosis-Related Group) Business Solutions Lead
About Us Abacus Insights is transforming how data works for health plans. Our mission is simple: make healthcare data usable, so the people responsible for care and cost decisions can act faster, with confidence. We help health plans break down data silos to create a single, trusted data foundation. That foundation powers better decisions—so plans can improve outcomes, reduce waste, and deliver better experiences for members and providers alike. Backed by $100M from top investors, we’re tackling big challenges in an industry that’s ready for change. Our platform enables GenAI use cases by delivering clean, connected, and reliable healthcare data to support automation, prioritization, and decision workflows—and it’s why we are leading the way. Our innovation begins with people. We are bold, curious, and collaborative—because the best ideas come from working together. We embrace the thoughtful use of AI and automation to drive innovation and efficiency, and we look for individuals who are curious and adaptable—those excited to leverage emerging technologies to enhance how we work—while keeping human insight, connection, and our clients at the center of every decision. Ready to make an impact? Join us and let’s build the future together.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...