Vice President, Revenue Integrity – DRG, DRGV

Job not on LinkedIn

🔥 0 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🔴 Lead

👔 Vice President

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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EnableComp

WebsiteLinkedInAll Job Openings

501 - 1000 employees

💼 Consulting

🛡️ Insurance

📦 Logistics

💰 Venture Round on 2022-07

Consulting • Insurance • Logistics

EnableComp is a company that specializes in revenue cycle management (RCM) for healthcare providers and health systems across the United States. They focus on processing complex claims related to Veterans Administration, Workers' Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid, as well as denial management for all payer classes. By leveraging intelligent automation and their proprietary E360 RCM™ platform, EnableComp helps healthcare providers increase revenue, control costs, and streamline billing processes. With expertise in handling complex claims, the company ensures accurate and timely reimbursement, providing significant uplift to collections and improving the financial performance of its clients.

📋 Description

• Lead and supervise Revenue Recovery products under the Denials umbrella, including DRG/DRGV, Medical Necessity Denials, and ED Downgrades. • Serve as a subject matter expert for Revenue Integrity products. • Define departmental goals, financial targets, and key performance indicators aligned with company objectives. • Help set the strategic direction of Revenue Recovery and identify continuous improvement opportunities. • Oversee quality and productivity metrics and benchmarks. • Create, communicate, and train teams on process changes and operational best practices. • Ensure processes and inventory support monthly, quarterly, and annual revenue expectations. • Hire, train, supervise, and evaluate staff, including goal planning, performance reviews, workload distribution, and performance monitoring. • Coordinate organizational resources for client and project action plans. • Collaborate with senior leaders on corporate planning, resource allocation, and strategic partnerships. • Set daily priorities and ensure impactful work is appropriately staffed. • Monitor performance metrics and provide stakeholder reporting with corrective action plans. • Explain variances to management involving DRG reviews, billing activity, and revenue metrics. • Analyze operational processes and systems for improvement opportunities and SOP enhancements. • Manage high-level client relationships, performance updates, collaboration, and escalated concerns. • Oversee training materials, onboarding, ongoing education, and quality improvement. • Develop a high-performing, scalable organizational structure through leadership, coaching, and accountability. • Maintain knowledge of HIPAA, coding guidelines, regulatory and compliance requirements, and ensure staff adherence. • Maintain expertise in DRG coding, clinical documentation, and reimbursement methodologies. • Perform other duties as required.

🎯 Requirements

• Bachelor’s degree in health information management, Nursing, Healthcare Administration, Business, or related field required; Master’s degree preferred. • Active Certified Coding Specialist (CCS), RHIT, or RHIA strongly preferred. • 7-10 years’ progressive leadership experience in healthcare reimbursement, including 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. • Ability to operate effectively at strategic and operational levels. • Timely and regular attendance. • Equivalent combination of education and experience will be considered. • Ability to perform essential duties satisfactorily; reasonable accommodations may be made for qualified individuals with disabilities. • Adherence to EnableComp’s Core Values, Vision, and Mission. • Travel 0–10%; general office environment. • Strong written and oral communication skills. • Experience working in a production environment and meeting deadlines. • Excellent people skills for interfacing with multiple internal stakeholders. • Proven success obtaining quantifiable results and setting priorities for direct reports. • Organized and able to 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 for management.

🏖️ Benefits

• Professional growth and development opportunities • Tools, resources, and support for career development • Flexible and family-oriented work environment • Work-life balance support • Remote work option