Vice President, Transformation Services – Denials Prevention

🔥 6 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

⏰ Full Time

🔴 Lead

👔 Vice President

👻 Ghost score 10%

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Med-Metrix

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2010

🏥 Healthcare

☁️ SaaS

💰 Private equity on 2025-09

Healthcare • SaaS

Med-Metrix is a company for which only a minimal web presence was provided (the page only displayed "Loading application... Your web browser must have JavaScript enabled... "). No product, market, or mission details were included in the supplied text. Based on the company name alone, it plausibly focuses on medical or clinical metrics, analytics, or healthcare software, but that is speculative and not confirmed by the provided information. Further public details would be required to be more specific.

📋 Description

• Lead enterprise-wide denial prevention strategy and transformation across hospital revenue cycle operations • Identify and quantify opportunities to improve revenue yield by preventing avoidable revenue leakage before claims are submitted • Analyze denial, write-off, payer, and reimbursement data to identify root causes, emerging trends, and transformation opportunities • Establish a denial prevention framework focused on upstream prevention and first-pass payment • Develop prioritized transformation strategies based on financial impact, preventability, payer trends, operational performance, and implementation feasibility • Drive performance toward industry benchmarks for denial rates, preventable denials, clean claims, write-offs, overturn rates, and first-pass payment • Lead root-cause initiatives across Patient Access, Prior Authorization, Utilization Management, CDI, Coding, Revenue Integrity, Billing, Clinical Operations, and Payer Management • Develop payer-specific prevention strategies addressing authorization, medical necessity, clinical validation, DRG downgrades, level of care, coding, timely filing, eligibility, and payment policy issues • Identify payer behavior and policy changes and develop mitigation strategies • Partner with Managed Care and payer relations teams on systemic payer issues, contractual opportunities, and payer escalation • Define and monitor leading and lagging KPIs for denial outcomes and upstream prevention effectiveness • Evaluate workflows and technology to move edits and interventions earlier in the revenue cycle • Quantify transformation outcomes including net new revenue, avoided leakage, cash acceleration, reduced write-offs, and cost-to-collect improvement • Partner with operational leaders to ensure strategies are implemented, adopted, measured, and sustained • Develop standardized denial prevention methodologies, playbooks, benchmarks, and best practices across clients • Support client assessments, business development, and executive presentations by articulating opportunities and financial value • Foster continuous improvement, accountability, data-driven decision-making, and proactive revenue protection

🎯 Requirements

• 10 years of progressive leadership experience in Revenue Cycle Management and Denials work • Bachelor's degree in Business Administration, Healthcare Administration, Finance, or a related field preferred • Proven experience in a leadership role within revenue cycle services, preferably in a healthcare hospital-based healthcare setting • Strong understanding of revenue cycle management principles and practices, with a demonstrated ability to deliver high-quality services to clients • Knowledge of state and federal governmental, legal, and regulatory provisions related to front-end, middle and backend revenue cycle operations • Excellent leadership skills, including the ability to motivate, mentor, and develop a high-performing team • Proficiency in revenue cycle management systems, electronic health records (EHR), and client management tools • Ability to adapt to a fast-paced and changing environment, managing multiple priorities and deadlines effectively • Proficiency in Microsoft Office Suite • Strong interpersonal skills, ability to communicate well at all levels of the organization • Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses • High level of integrity and dependability with a strong sense of urgency and results oriented • Excellent written and verbal communication skills required • Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes • Ability to move around the work area; light lifting required; sit; perform manual tasks; operate tools and office equipment; extend arms; kneel; talk and hear • Ability to follow directions, collaborate with others, and handle stress