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Vice President, DRG (REMOTE)

1 hour, 15 minutes ago
United States
Full-time
Executive
Operations Manager
Operations
HIPAA
Apply Now
EnableComp

EnableComp

EnableComp specializes in complex claims and specialty revenue cycle management solutions for healthcare providers, focusing on optimizing reimbursements for various claims types, including VA, Workers' Compensation, and Motor Vehicle Accidents, throug...

Insurance
251-1K
Founded 2000
View All Jobs 10

Description

  • Lead Revenue Recovery products under the denials umbrella, including DRG/DRGV, medical necessity denials, and ED downgrades.
  • Set departmental goals, financial targets, and key performance indicators aligned with company objectives.
  • Guide the strategic direction of Revenue Recovery and identify continuous improvement opportunities with senior leadership.
  • Oversee development of quality and productivity metrics and benchmarks based on industry and internal standards.
  • Create, communicate, and train teams on process changes, operational best practices, and SOP enhancements.
  • Ensure processes and inventory support monthly, quarterly, and annual revenue expectations.
  • Hire, train, coach, and oversee staff, including goal planning, performance reviews, workload distribution, and performance monitoring.
  • Coordinate resources across the organization to execute action plans for clients and projects.
  • Collaborate with senior leaders on planning, resource allocation, and strategic partnerships.
  • Monitor key performance metrics, report results to stakeholders, explain variances, and prepare corrective action plans.
  • Participate in client relationships, provide performance updates, and resolve escalated concerns.
  • Develop training materials and support onboarding, ongoing education, and quality improvement.
  • Maintain regulatory and compliance adherence, including HIPAA and coding guidelines.
  • Maintain strong knowledge of DRG coding, clinical documentation, and reimbursement methodologies.

Requirements

  • 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.
  • 5+ years of experience 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/reporting tools.
  • Demonstrated ability to operate effectively at both strategic and operational levels.
  • Strong written and oral communication skills with the ability to manage multiple priorities and projects.
  • Timely and regular attendance is required.
  • Travel required at 0-10%.
  • Experience in a production environment and ability to meet deadlines is expected.
  • Health care experience and familiarity with payer or provider data sets is preferred.

Benefits

  • Remote full-time work arrangement.
  • Opportunity to work for a multi-year Top Workplaces award recipient.
  • Career growth in a company that emphasizes professional development and internal leadership development.
  • Supportive culture that values work-life balance and flexibility.
  • Opportunity to work with a fast-growing industry leader recognized by Black Book and Inc. 5000.

Interested in this position?

Apply directly on the company website

Apply Now

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