Vice President, DRG (REMOTE)
EnableComp
- Franklin, Tennessee, United States
- Franklin, Tennessee, United States
À propos
Position Summary The VP, DRG is responsible for providing leadership and supervision to the Revenue Recovery products under the Denials umbrella, including Diagnosis-Related Group (DRG & DRGV), and Medical Necessity Denials and Emergency (ED) Downgrades, to obtain quantifiable results and set priorities for direct reports. The VP leads dedicated product and service teams across Revenue Integrity to deliver best-in-class results, ensures clinical coding integrity and regulatory compliance, and reports regularly to senior management on obstacles, challenges, and opportunities that impact the company’s revenue projections. The role is accountable for developing and supporting leadership within the department, driving operational performance, client satisfaction, and continuous improvement across Revenue Recovery.
Job Responsibilities
Acts as a subject matter expert in EnableComp 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.
Assist in setting the strategic direction of Revenue Recovery and identify areas of continuous improvement in conjunction with senior leadership.
Oversee the development of quality and productivity metrics and benchmarks for Revenue Recovery functions based on industry standards and internal benchmarks.
Act as a key resource for creation, communication, and training of process changes and operational best practices within Revenue Recovery.
Ensure processes and inventory are in place to meet monthly, quarterly, and annual revenue expectations.
Responsible for hiring, staff training, and oversight, including annual goal planning, performance reviews, workload distribution, and regular monitoring of team performance.
Coordinate resources throughout the organization to address action plans for assigned clients and projects.
Collaborate cross‑functionally with senior leaders to guide corporate planning, resource allocation, and strategic partnerships.
Set daily priorities to ensure the most impactful work is prioritized and appropriately staffed.
Measure and monitor key performance metrics, deliver concise reporting to stakeholders, and develop corrective action plans for variances when appropriate.
Lead in explaining variances to management regarding DRG reviews, billing activity, and revenue metrics.
Research and analyze 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 and resolution of escalated concerns.
Oversee development of training materials and evaluate trends to support onboarding, ongoing education, and quality improvement.
Build a high‑performing team through effective leadership, coaching, and accountability to create a scalable organizational structure.
Maintain current knowledge of all regulatory and compliance requirements (including HIPAA and coding guidelines) and ensure staff adherence through training and policy updates.
Maintain 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 a 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 EnableComp’s core values, vision, and mission.
Travel 0–10%; general office environment.
Strong and professional written and oral communication skills.
Has worked in a production environment and can meet deadlines; provides examples of goal measurement for self and team.
Excellent people skills to interface with multiple internal stakeholders.
Proven success in obtaining quantifiable results from and setting priorities for direct reports; describes management of individual goals.
Organized and can handle multiple projects simultaneously.
Healthcare experience and familiarity with payer or provider data sets.
Ability to set and manage multiple priorities among several teams.
Experience communicating obstacles and challenges and developing action plans to present to management; provides examples.
Equal Employment Opportunity Statement EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital status, disability, or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment.
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Compétences linguistiques
- English
Avis aux utilisateurs
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