Vice President, Revenue Integrity - DRG & DRGV

Accountabilities

• Serve as a subject matter expert in revenue integrity services, including DRG and DRGV reviews, medical necessity denials, and emergency department downgrades.

• Define departmental objectives, financial targets, productivity standards, and key performance indicators aligned with broader organizational goals.

• Partner with senior leadership to establish the strategic direction of revenue recovery operations and identify opportunities for continuous improvement.

• Develop and maintain quality, productivity, and performance benchmarks based on industry standards and internal operational data.

• Ensure appropriate processes, staffing, and inventory management are in place to meet monthly, quarterly, and annual revenue expectations.

• Lead workforce planning, recruitment, onboarding, training, performance reviews, goal setting, workload distribution, and ongoing performance management.

• Establish daily priorities and allocate resources to ensure the highest-impact activities receive appropriate attention and staffing.

• Monitor operational and financial performance, deliver clear reports to stakeholders, investigate variances, and implement corrective action plans where necessary.

• Analyze DRG review outcomes, billing activity, and revenue metrics, communicating performance trends and variances to management.

• Coordinate resources across departments to execute client action plans, manage projects, and resolve operational challenges.

• Collaborate with senior leaders on corporate planning, resource allocation, strategic partnerships, and organizational development.

• Build and maintain strong client relationships through regular performance updates, collaborative problem-solving, and timely resolution of escalated concerns.

• Develop and enhance standard operating procedures, training materials, and process communications to support consistent execution, employee onboarding, and ongoing education.

• Lead, coach, and motivate teams while establishing clear accountability, measurable goals, and a scalable organizational structure.

• Maintain current knowledge of applicable healthcare regulations, HIPAA requirements, coding guidelines, and reimbursement standards, ensuring compliance through training, policies, and operational processes.

• Evaluate systems, workflows, and operational data to identify improvement opportunities, strengthen quality, and increase revenue recovery effectiveness.

• Perform additional duties as needed to support departmental and organizational objectives.

Requirements:

• Bachelor's degree in health information management, nursing, healthcare administration, business, or a related field required; a master's degree is preferred.

• Active Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA) credential strongly preferred.

• 7–10 years of progressive leadership experience in healthcare reimbursement, including at least 5 years in clinical denials or inpatient claims environments.

• Strong expertise in inpatient coding, DRG reimbursement methodologies, medical record auditing, clinical documentation, and payer guidelines.

• Experience working in hospital revenue cycle environments and using large-scale data analysis and reporting tools.

• Demonstrated ability to operate effectively at both strategic and operational levels, translating business objectives into measurable results.

• Experience working collaboratively with internal teams while maintaining client-facing or client-support responsibilities.

• Proven success in setting goals, measuring team performance, prioritizing workloads, and achieving quantifiable results through direct reports.

• Strong leadership, coaching, and people management skills, with the ability to motivate teams, build accountability, and support professional development.

• Excellent written and verbal communication skills, including the ability to explain complex operational and financial issues to senior stakeholders and clients.

• Strong analytical and problem-solving skills, with the ability to identify operational obstacles, evaluate performance trends, and develop actionable improvement plans.

• Excellent organizational and project management abilities, including the capacity to manage competing priorities across multiple teams and initiatives.

• Familiarity with healthcare data and payer or provider datasets, along with the ability to work effectively in a deadline-driven production environment.

• Consistent attendance, reliability, sound judgment, and a professional approach to stakeholder relationships.

• Willingness to travel approximately 0–10% as required. The position is remote, with occasional travel and work in a general office environment where needed.

• Equivalent combinations of education and experience may be considered. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Benefits:

• Remote work arrangement within the United States.

• Full-time employment in a senior leadership role.

• Opportunity to influence revenue integrity strategy, operational performance, and organizational growth.

• Professional opportunity to lead specialized healthcare reimbursement and revenue recovery functions.

• Specific salary range, healthcare coverage, retirement benefits, paid leave, and other compensation details are not specified in the source listing.