Vice President, Revenue Integrity - DRG & DRGV (REMOTE)

Job Responsibilities Include

• Acts as a subject matter expert in the company Revenue Integrity related products, including DRG & DRGV, and Medical Necessity Denials & ED Downgrades).

• Define and establish departmental goals, financial targets, and key performance indicators that align with company objectives.

• Assists in setting the strategic direction of the Revenue Recovery and identifies areas of continuous improvement in conjunction with the senior leadership team.

• Oversee the development of quality and productivity metrics and benchmarks for Revenue Recovery functions based on industry standards and internal benchmarks.

• Acts as a key resource with the creation, communication, and training of process changes, and operational best practices within Revenue Recovery.

• Ensure the processes and inventory are in place to hit monthly, quarterly, and annual revenue expectations for the company.

• Responsible for hiring, staff training, and oversight, including annual goal planning, performance reviews, workload distribution, and regular monitoring of team performance. Ability to direct and motivate staff.

• Coordinate resources throughout the organization to address action plans for assigned clients and projects.

• Collaborate cross-functionally with other senior leaders to guide corporate planning, resource allocation, and strategic partnerships.

• Responsible for setting daily priorities to ensure the most impactful work is prioritized and appropriately staffed.

• Measures and monitors key performance metrics and delivers concise performance reporting to stakeholders with corrective action plans for variances when appropriate. Ensures these metrics are cascaded throughout the organization.

• Take the lead in explaining variances to management on a regular basis regarding DRG reviews, billing activity, and revenue metrics.

• Researches and analyzes operational processes and systems to identify process improvement opportunities and SOP enhancements.

• Participate in high-level client relationships and ensure client satisfaction through regular performance updates, collaboration, and resolution of escalated concerns.

• Oversee the development of training materials and evaluates trends to support onboarding, ongoing education, and quality improvement.

• Develops a high-performing team through effective leadership, coaching, and accountability to build a high-performing, scalable organizational structure.

• Maintain a current working knowledge of all related regulatory and compliance requirements (including HIPAA and coding guidelines) and ensures staff adherence through training, process updates, and policy alignment.

• Maintain a strong knowledge of DRG coding, clinical documentation, and reimbursement methodologies.

• Other duties as required

Requirements & Qualifications

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

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

• 7-10 years’ of progressive leadership experience in healthcare reimbursement, with 5+ years in clinical denials or inpatient claims environments.

• Experience working with internal teams while serving in a client facing or client support role.

• Strong understanding of inpatient coding, DRG reimbursement methodology, medical record auditing, and payer guidelines.

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

• Demonstrated ability to operate effectively at both strategic and operational levels.

• Timely and regular attendance.

• Equivalent combination of education and experience will be considered

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Special Considerations & Prerequisites

• Practices and adheres to the company’s Core Values, Vision and Mission.

• Travel 0-10%; general office environment

• Strong and professional written and oral communications skills.

• Has worked in a production environment and can meet deadlines. Provide examples of goals measurement for yourself and your team.

• Excellent people skills to interface with multiple internal stakeholders.

• Proven success in obtaining quantifiable results from and setting priorities for direct reports. Describe how you manage to individual goals.

• Organized and can handle multiple projects simultaneously.

• Health care experience and familiarity with payer or provider data sets.

• Ability to set and manage multiple priorities among several teams.

• Experience communicating obstacles & challenges and developing action plans to present to management. Provide examples.