VP, Revenue Optimization & Reimbursement

Emory Healthcare•Tucker, GA

6d•Remote

About The Position

The Vice President of Revenue Optimization & Government Reimbursement provides executive leadership for enterprise revenue integrity, Charge Description Master (CDM) governance, government reimbursement, and revenue optimization strategy across Emory Healthcare Reporting to the Chief Revenue Cycle Officer, this role is responsible for the strategic direction, operational performance, and financial outcomes of both Hospital Billing (HB) and Professional Billing (PB) revenue optimization functions, as well as the Government Reimbursement team The Vice President oversees Revenue Integrity, CDM, and Government Reimbursement and partners closely with Charge Capture, Finance, Managed Care, Compliance, and clinical leadership to ensure accurate, compliant, and optimized revenue realization across all payers, with specific accountability for governmental reimbursement strategy and regulatory alignment This role serves as a key enterprise executive partner driving revenue sustainability, regulatory compliance, and margin improvement through innovation, analytics, and system optimization

Requirements

Bachelor's, Healthcare Administration, Business Administration with a Healthcare or Finance Concentration or equivalent
10+ years of progressive healthcare revenue cycle leadership experience, including executive oversight of revenue integrity and/or government reimbursement functions within a large, complex health system
Deep expertise in revenue integrity, CDM governance, and middle revenue cycle operations
Executive-level knowledge of Medicare, Medicaid, and governmental reimbursement methodologies
Experience in large academic health systems utilizing Epic
Strong understanding of healthcare reimbursement, regulatory compliance, and audit risk
Proven executive leadership, change management, and strategic planning capabilities

Nice To Haves

Registered Nurse; Coding, Billing, or Revenue Cycle certification; Master's degree preferred
Experience leading large-scale financial optimization initiatives and governmental reimbursement strategy yielding multi-million-dollar impact

Responsibilities

Provide enterprise executive leadership for revenue integrity, charge capture alignment, and revenue optimization strategy across HB and PB
Establish enterprise governance structures to ensure alignment with health system financial and operational priorities
Identify, quantify, and remediate revenue leakage through analytics, operational redesign, and technology enablement
Drive performance improvement initiatives impacting net revenue, compliance, and denial prevention
Provide executive oversight of Government Reimbursement strategy, including Medicare, Medicaid, and other federal/state reimbursement programs
Ensure organizational readiness and compliance with evolving CMS and state regulatory requirements
Oversee cost report strategy and optimization
Oversee Disproportionate Share Hospital (DSH) programs
Oversee Graduate Medical Education (GME) reimbursement
Oversee supplemental payment programs
Oversee regulatory filing and audit coordination
Partner with Finance and Policy leaders to model reimbursement impacts and optimize governmental revenue streams
Serve as executive liaison for governmental reimbursement audits, appeals, and regulatory reviews
Oversee enterprise CDM strategy, maintenance, and governance
Ensure compliant and optimized charging aligned with regulatory, payer, and contractual requirements
Lead enterprise CDM audits, charge reviews, and remediation initiatives
Drive standardization of charging practices across the system
Partner with clinical, operational, and revenue cycle leaders to improve documentation impacting charge capture and reimbursement
Support provider and departmental education related to charging accuracy and compliance
Align charge capture workflows with digital and AI-enabled solutions
Leverage advanced analytics to identify performance gaps, reimbursement risk, and optimization opportunities
Establish executive KPIs and dashboards for revenue optimization and government reimbursement performance
Partner with Digital and IT teams to deploy automation, AI, and system enhancements supporting middle revenue cycle transformation
Serve as an enterprise executive partner across Revenue Cycle, Finance, Digital, Compliance, Legal, Managed Care, and Clinical Operations
Lead cross-functional initiatives to improve middle revenue cycle performance and governmental reimbursement outcomes
Represent Revenue Optimization and Government Reimbursement at executive leadership forums
Mentor and develop senior leaders and high-potential talent
Additional Duties as Assigned