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

EnableComp•United States - Remote, TN

13d•Remote

About The Position

The Vice President, Revenue Integrity is a subject matter expert in EnableComp’s Revenue Integrity products, including DRG and DRGV, Medical Necessity Denials, and ED Downgrades. The role helps set the strategic direction of Revenue Recovery and establishes departmental goals, financial targets, and performance indicators aligned with company objectives. It oversees quality and productivity standards, operational processes, staffing, inventory, and performance reporting to support revenue expectations and continuous improvement. This leader manages and develops staff, coordinates organizational resources for client and project action plans, and collaborates with senior leaders on corporate planning, resource allocation, and strategic partnerships. The role also supports high-level client relationships, addresses escalated concerns, and oversees training and quality-improvement efforts. It maintains working knowledge of regulatory and compliance requirements, including HIPAA and coding guidelines, and expertise in DRG coding, clinical documentation, and reimbursement methodologies. The position is remote, with 0–10% travel, in a general office environment. The role requires regular and timely attendance and may include other duties as required. Reasonable accommodations may be made for qualified individuals with disabilities to perform essential functions.

Requirements

Bachelor’s degree in health information management, Nursing, Healthcare Administration, Business, or a related field; equivalent combinations of education and experience will be considered.
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.
Strong written and oral communication skills.
Experience in a production environment and ability to meet deadlines.
Ability to set priorities for direct reports and achieve quantifiable results.
Ability to manage individual goals and multiple priorities across several teams and projects.
Strong organizational and interpersonal skills for interfacing with multiple internal stakeholders.
Experience communicating obstacles and challenges, developing action plans, and presenting them to management.
Healthcare experience and familiarity with payer or provider data sets.
Timely and regular attendance.
Ability to perform the essential duties satisfactorily; reasonable accommodations may be available for qualified individuals with disabilities.

Nice To Haves

Master’s degree.
Active Certified Coding Specialist (CCS), RHIT, or RHIA credential.

Responsibilities

Serve as a subject matter expert on EnableComp 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 establish the strategic direction of Revenue Recovery and identify continuous-improvement opportunities with senior leadership.
Oversee quality and productivity metrics and benchmarks for Revenue Recovery functions, using industry and internal standards.
Create, communicate, and train teams on process changes and operational best practices within Revenue Recovery.
Ensure processes and inventory support monthly, quarterly, and annual revenue expectations.
Hire, train, and oversee staff, including goal planning, performance reviews, workload distribution, and ongoing performance monitoring.
Direct and motivate staff and develop a high-performing, scalable organizational structure through leadership, coaching, and accountability.
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.
Measure and monitor key performance metrics, report performance to stakeholders, and develop corrective action plans for variances when appropriate.
Ensure performance metrics are cascaded throughout the organization and explain variances to management regarding DRG reviews, billing activity, and revenue metrics.
Research and analyze operational processes and systems to identify process improvements and SOP enhancements.
Participate in high-level client relationships, provide regular performance updates, collaborate with clients, and resolve escalated concerns.
Oversee development of training materials and evaluate trends to support onboarding, ongoing education, and quality improvement.
Maintain current knowledge of regulatory and compliance requirements, including HIPAA and coding guidelines, and ensure staff adherence through training, process updates, and policy alignment.
Maintain strong knowledge of DRG coding, clinical documentation, and reimbursement methodologies.
Perform other duties as required.