Vice President DRG

remote-job.net Job summary: 💶 Salary: not specified ⏰ Weekly hours: Full-time 🔍 Recommended experience: Senior 🎓 Recommended education: Bachelor required; Master in Health Information Management, Nursing, Healthcare Administration, or Business preferred 🏭 Industry: Healthcare Main responsibilities: Lead the Revenue Recovery/Denials product lines (DRG, Medical Necessity, ED Downgrades). Set targets/KPIs and ensure achievement of revenue and performance goals. Build, lead, and develop teams including hiring, training, and performance management. Key requirements: 7–10 years of leadership experience in Healthcare Reimbursement; ≥5 years of experience in clinical denials/inpatient claims. Bachelor’s degree required (Master’s preferred); CCS/RHIT/RHIA certifications strongly preferred. Deep knowledge of DRG coding, clinical documentation, and hospital revenue cycle processes. About the company: EnableComp provides specialized revenue cycle management solutions for healthcare organizations and has more than 24 years of industry experience. The company operates the unified E360 RCM™ platform for intelligent automation, processes more than 10 million claims, and uses proprietary algorithms together with human expertise to improve the financial sustainability of hospitals, health systems, and outpatient surgery centers. EnableComp delivers solutions across the entire reimbursement cycle, including services for the Veterans Administration, workers’ compensation, motor vehicle accidents, out-of-state Medicaid claims, and denial management for all payers. Goals include accelerated cash flow, higher and more accurate revenue, clean accounts receivable, reduced denials, and data-driven performance management. The company is a multiple-time Top Workplace awardee, was ranked No. 1 in Specialty Revenue Cycle Management by Black Book in 2024, and has been among the fastest-growing private companies in the U.S. for eleven years (Inc. 5000). Responsibilities: Provide leadership and oversight for Revenue Recovery products within Denials (including DRG/DRGV, Medical Necessity Denials, ED Downgrades). Define and implement departmental objectives, financial targets, and KPIs in alignment with company goals. Set the strategic direction for revenue recovery activities and identify and implement continuous improvements. Develop quality and productivity metrics and benchmarks. Create, communicate, and train on process changes and best practices. Ensure processes and inventory management to achieve monthly, quarterly, and annual revenue goals. Recruit, train, plan performance, review, and continuously monitor teams; coordinate resources for client projects. Collaborate cross-functionally with senior leadership, manage priorities, and report performance metrics including corrective actions. Maintain high-level client contact, ensure client satisfaction, and manage escalations. Ensure compliance with regulatory requirements (e.g., HIPAA) and maintain clinical coding integrity. Qualifications: Bachelor’s degree in Health Information Management, Nursing, Healthcare Administration, Business, or a related field required; Master’s preferred. Active certifications such as CCS, RHIT, or RHIA are strongly preferred. 7–10 years of progressive leadership experience in Healthcare Reimbursement, including at least 5 years in clinical denials or inpatient claims. Experience in client-facing roles and collaboration with internal teams. Deep understanding of inpatient coding, DRG reimbursement methodology, clinical documentation review, and payer policies. Experience with hospital revenue cycle environments and large data/reporting tools. Ability to operate strategically and operationally; strong communication and organizational skills. Travel required 0–10%; general office environment; punctual and reliable work ethic. Equivalent combinations of education and experience will be considered; reasonable accommodations for people with disabilities available. Benefits: Investment in employees—training and professional development actively supported. Award-winning workplace (Top Workplace, Black Book recognition, Inc. 5000). Family-oriented and flexible company culture. Occasional travel only 0–10%. Equal hiring practices / Equal Opportunity Employer.