Vice President, Transformation Services – Denials Prevention

Jobtailor; Deutschland; Remote; EUR 90.000 - 130.000; Vollzeit

Zusammenfassung

Jobtailor is seeking a senior leader to head enterprise-wide denial prevention and revenue-cycle transformation. You will drive upstream prevention, analyze denial and payer data, and collaborate across Patient Access, CDI, Coding, and Billing to reduce leakage and improve first-pass payments.

Strong leadership and analytics are essential in a healthcare hospital setting. You will establish frameworks, develop prioritized strategies, monitor KPIs, and partner with stakeholders to implement

Qualifikationen

• 10 years of progressive leadership experience in Revenue Cycle Management and Denials work.
• Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field preferred.
• Proven leadership in revenue cycle services, preferably in a healthcare hospital-based setting.
• Knowledge of state and federal provisions related to front-end, middle and backend revenue cycle operations.
• Excellent leadership skills with ability to mentor and develop a team.
• Proficiency in revenue cycle management systems, EHR, and client management tools.
• Ability to adapt to a fast-paced environment and manage multiple priorities.

Aufgaben

• 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 and trends.
• Establish a denial prevention framework focused on upstream prevention and first-pass payment.
• Develop prioritized transformation strategies based on financial impact, preventability, payer trends, and feasibility.
• Drive performance toward industry benchmarks for denial rates, preventable denials, 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, coding, and timely filing issues.
• Identify payer behavior and policy changes and develop mitigation strategies.
• Partner with Managed Care and payer relations teams on systemic payer issues and contractual opportunities.
• Define and monitor KPIs for denial outcomes and upstream prevention effectiveness.
• Evaluate workflows and technology to move interventions earlier in the revenue cycle.
• Quantify transformation outcomes including net revenue, avoided leakage, and cost-to-collect improvements.
• Partner with operational leaders to ensure strategies are implemented, adopted, and sustained.
• Develop standardized denial prevention methodologies, playbooks, and benchmarks across clients.
• Support client assessments, business development, and executive presentations by articulating opportunities and financial value.
• Foster continuous improvement and proactive revenue protection.

Kenntnisse

Revenue Cycle Management

Denial Prevention Strategy

Leadership in Healthcare

Data Analysis and Transformation

KPI Monitoring and Evaluation

Ausbildung

Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field

Tools

Microsoft Office Suite

Revenue Cycle Management Systems

EHR/Electronic Health Records

Client Management Tools

Jobbeschreibung

• 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

Core Competencies

Demonstrates extensive expertise in Revenue Cycle Management and Denial Prevention, with a focus on developing and implementing strategies that enhance financial performance and operational efficiency. Proven ability to lead teams, analyze complex data, and drive continuous improvement in healthcare settings.

Highest-signal resume keywords

• Revenue Cycle Management


• Denial Prevention Strategy


• Leadership in Healthcare


• Data Analysis and Transformation


• KPI Monitoring and Evaluation

ATS Optimization Keywords

Hard Skills

• Revenue Cycle Management Principles


• Denial Analysis


• Financial Impact Assessment


• Payer Behavior Analysis


• Regulatory Compliance Knowledge


• EHR Proficiency


• Client Management Tools


• Transformation Strategy Development


• Performance Benchmarking


• Denial Prevention Methodologies

Soft Skills

• Leadership Skills


• Interpersonal Communication


• Problem Solving
  
• Creative Thinking


• Team Development

Industry Keywords

• Healthcare Administration


• Denials Management


• Patient Access


• Utilization Management


• Clinical Documentation Improvement (CDI)


• Coding


• Billing


• Payer Relations


• Contractual Opportunities


• Continuous Improvement

Tools & Technologies

• Microsoft Office Suite


• Revenue Cycle Management Systems


• Electronic Health Records (EHR)