Vice President, Transformation Services – Denials Prevention

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

📋 Description

• Spearhead the enterprise-wide denial prevention strategy and transformation within hospital revenue cycle operations.

• Recognize and assess opportunities to enhance revenue yield by averting avoidable revenue leakage prior to claims submission.

• Examine denial, write-off, payer, and reimbursement data to uncover root causes, emerging trends, and opportunities for transformation.

• Create a denial prevention framework centered on upstream prevention and first-pass payment.

• Formulate prioritized transformation strategies informed by financial impact, preventability, payer trends, operational performance, and implementation feasibility.

• Propel performance toward industry benchmarks for denial rates, preventable denials, clean claims, write-offs, overturn rates, and first-pass payments.

• Lead root-cause initiatives across Patient Access, Prior Authorization, Utilization Management, CDI, Coding, Revenue Integrity, Billing, Clinical Operations, and Payer Management.

• Formulate payer-specific prevention strategies that address authorization, medical necessity, clinical validation, DRG downgrades, level of care, coding, timely filing, eligibility, and payment policy issues.

• Recognize payer behavior and policy modifications and devise mitigation strategies.

• Collaborate with Managed Care and payer relations teams to address systemic payer issues, contractual opportunities, and payer escalation.

• Define and track leading and lagging KPIs related to denial outcomes and the effectiveness of upstream prevention.

• Assess workflows and technology to implement edits and interventions earlier in the revenue cycle.

• Quantify transformation outcomes, including net new revenue, avoided leakage, cash acceleration, reduced write-offs, and improved cost-to-collect.

• Collaborate with operational leaders to ensure that strategies are implemented, adopted, measured, and sustained.

• Develop standardized denial prevention methodologies, playbooks, benchmarks, and best practices across clients.

• Assist in client assessments, business development, and executive presentations by effectively communicating opportunities and financial value.

• Promote continuous improvement, accountability, data-driven decision-making, and proactive revenue protection.

⛳️ Requirements

• A decade of progressive leadership experience in Revenue Cycle Management and Denials work.

• A Bachelor's degree in Business Administration, Healthcare Administration, Finance, or a related field is preferred.

• Demonstrated experience in a leadership role within revenue cycle services, ideally in a healthcare hospital-based setting.

• Comprehensive understanding of revenue cycle management principles and practices, with a proven ability to deliver high-quality services to clients.

• Familiarity with state and federal governmental, legal, and regulatory provisions associated with front-end, middle, and backend revenue cycle operations.

• Exceptional leadership abilities, including the capacity to inspire, mentor, and cultivate a high-performing team.

• Proficiency in revenue cycle management systems, electronic health records (EHR), and client management tools.

• Capability to adapt to a dynamic and fast-paced environment while effectively managing multiple priorities and deadlines.

• Proficient in Microsoft Office Suite.

• Strong interpersonal skills with the ability to communicate effectively at all organizational levels.

• Excellent problem-solving and creative abilities, with the judgment to make informed decisions based on accurate and timely analyses.

• High integrity and dependability, coupled with a strong sense of urgency and results-oriented mindset.

• Outstanding written and verbal communication skills are essential.

• Must have a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes.

• Ability to navigate the work area, perform light lifting, sit, engage in manual tasks, operate tools and office equipment, extend arms, kneel, talk, and listen.

• Capacity to follow directions, collaborate with others, and manage stress effectively.

🏝️ Benefits

• Competitive salary and performance incentives.

• Comprehensive health and wellness benefits.

• Opportunities for professional development and career advancement.

• Flexible working hours and a supportive work environment.