Vice President, Revenue Integrity – DRG, DRGV

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Lead and oversee Revenue Recovery initiatives within the Denials category, encompassing DRG/DRGV, Medical Necessity Denials, and ED Downgrades.

• Act as a subject matter expert for Revenue Integrity products.

• Establish departmental objectives, financial benchmarks, and key performance indicators that align with organizational goals.

• Assist in shaping the strategic direction of Revenue Recovery and pinpoint opportunities for continuous improvement.

• Manage quality and productivity metrics as well as benchmarks.

• Develop, communicate, and educate teams on process modifications and operational best practices.

• Ensure that processes and inventory align with monthly, quarterly, and annual revenue projections.

• Recruit, train, supervise, and assess staff, including goal setting, performance evaluations, workload distribution, and performance monitoring.

• Coordinate organizational resources to support client and project action plans.

• Collaborate with senior leadership on corporate strategy, resource distribution, and strategic partnerships.

• Establish daily priorities and ensure that impactful work is adequately resourced.

• Track performance metrics and deliver stakeholder reports along with corrective action strategies.

• Clarify variances to management related to DRG reviews, billing activities, and revenue metrics.

• Evaluate operational processes and systems for potential enhancements and SOP improvements.

• Manage high-level client relationships, performance updates, collaboration, and address escalated issues.

• Oversee the development of training materials, onboarding processes, ongoing education, and quality enhancement efforts.

• Cultivate a high-performing, scalable organizational structure through effective leadership, coaching, and accountability.

• Stay informed on HIPAA, coding standards, regulatory and compliance requirements, ensuring staff compliance.

• Maintain proficiency in DRG coding, clinical documentation, and reimbursement methodologies.

• Execute other duties as necessary.

⛳️ Requirements

• Bachelor’s degree in health information management, Nursing, Healthcare Administration, Business, or a related field is required; a Master’s degree is preferred.

• Active Certified Coding Specialist (CCS), RHIT, or RHIA is strongly preferred.

• 7-10 years of progressive leadership experience in healthcare reimbursement, including more than 5 years in clinical denials or inpatient claims settings.

• Experience collaborating with internal teams while also serving in a client-facing or client-support capacity.

• Strong knowledge of inpatient coding, DRG reimbursement methodologies, medical record auditing, and payer guidelines.

• Familiarity with navigating hospital revenue cycle environments and utilizing large-scale data/reporting tools.

• Ability to function effectively at both strategic and operational levels.

• Consistent and punctual attendance.

• Equivalent combinations of education and experience will be evaluated.

• Capable of performing essential duties satisfactorily; reasonable accommodations may be provided for qualified individuals with disabilities.

• Commitment to EnableComp’s Core Values, Vision, and Mission.

• Willingness to travel 0–10%; general office environment.

• Strong written and verbal communication skills.

• Experience working in a production environment and meeting deadlines.

• Excellent interpersonal skills for engaging with various internal stakeholders.

• Demonstrated success in achieving measurable results and prioritizing tasks for direct reports.

• Organized and capable of managing multiple projects concurrently.

• Background in healthcare and familiarity with payer or provider data sets.

• Ability to establish and manage multiple priorities across several teams.

• Experience in communicating challenges and developing action plans for management.

🏝️ Benefits

• Professional growth and development opportunities.

• Tools, resources, and support for career advancement.

• Flexible and family-oriented work culture.

• Support for work-life balance.

• Option for remote work.