Vice President, Revenue Integrity - DRG & DRGV (REMOTE)
About The Position
The Vice President, Revenue Integrity provides leadership and supervision for Revenue Recovery products under the Denials umbrella, including DRG and DRGV, Medical Necessity Denials, and Emergency Department downgrades. The role leads product and service teams to achieve quantifiable results, set priorities, and deliver strong client outcomes while maintaining clinical coding integrity and regulatory compliance. The VP sets departmental goals, financial targets, and performance measures; supports strategic planning and continuous improvement; and oversees operational performance, staffing, training, and team development. The position reports obstacles, challenges, opportunities, and performance variances to senior management, and works across the organization and with clients to support client satisfaction and revenue expectations.
Requirements
- Bachelor’s degree in health information management, nursing, healthcare administration, business, or a related field.
- 7–10 years of progressive leadership experience in healthcare reimbursement, including 5 or more years in clinical denials or inpatient claims environments.
- Experience working with internal teams 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 or reporting tools.
- Demonstrated ability to operate at both strategic and operational levels.
- Timely and regular attendance.
- Strong professional written and oral communication skills.
- Experience in a production environment and ability to meet deadlines.
- Strong interpersonal skills for working with multiple internal stakeholders.
- Demonstrated success obtaining quantifiable results from direct reports and setting and managing priorities across teams.
- Ability to manage multiple projects and priorities simultaneously.
- Healthcare experience and familiarity with payer or provider data sets.
- Experience communicating obstacles and challenges and developing action plans for management.
- Ability to perform the essential duties satisfactorily; reasonable accommodations may be made for qualified individuals with disabilities.
- Equivalent combinations of education and experience will be considered.
Nice To Haves
- Master’s degree.
- Active Certified Coding Specialist (CCS), RHIT, or RHIA credential.
Responsibilities
- Serve as a subject matter expert in Revenue Integrity products, including DRG and DRGV, Medical Necessity Denials, and ED Downgrades.
- Define departmental goals, financial targets, and key performance indicators aligned with company objectives.
- Help set the strategic direction of Revenue Recovery and identify continuous improvement opportunities with senior leadership.
- Oversee the development of quality and productivity metrics and benchmarks based on industry and internal standards.
- Support the creation, communication, and training of process changes and operational best practices.
- Ensure processes and inventory are in place to meet monthly, quarterly, and annual revenue expectations.
- Manage hiring, staff training, annual goal planning, performance reviews, workload distribution, and ongoing performance monitoring.
- Coordinate organizational resources to address action plans for assigned clients and projects.
- Collaborate with senior leaders on corporate planning, resource allocation, and strategic partnerships.
- Set daily priorities to ensure impactful work is prioritized and appropriately staffed.
- Monitor key performance metrics, report results to stakeholders, and develop corrective action plans for variances when appropriate.
- Explain variances to management relating to DRG reviews, billing activity, and revenue metrics.
- Analyze operational processes and systems to identify improvements and SOP enhancements.
- Participate in high-level client relationships, provide performance updates, and resolve escalated concerns.
- Oversee training materials and evaluate trends to support onboarding, continuing education, and quality improvement.
- Develop a high-performing team through leadership, coaching, accountability, and scalable organizational structures.
- Maintain knowledge of regulatory and compliance requirements, including HIPAA and coding guidelines, and ensure staff adherence through training and policy alignment.
- Maintain working knowledge of DRG coding, clinical documentation, and reimbursement methodologies.
- Perform other duties as required.
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What This Job Offers
Job Type
Full-time
Career Level
Executive
