Vice President, Revenue Integrity - DRG & DRGV (REMOTE)

Remote; San Francisco (CA); Remote; USD 180,000 - 240,000; Full time

Job summary

EnableComp is seeking a seasoned Revenue Integrity leader to guide the Revenue Recovery function in healthcare payer environments. You will set departmental goals, monitor financial targets, and drive continuous improvement with senior leadership.

You will oversee KPI development, staff hiring and training, and cross-functional collaboration to ensure on-time delivery of revenue objectives. Strong DRG and coding knowledge is essential, along with regulatory compliance and HIPAA familiarity.

Qualifications

• Bachelor's degree in HIM, nursing, healthcare administration, or related field.
• Active CCS, RHIT, or RHIA preferred.
• 7-10 years leadership experience in healthcare reimbursement, 5+ years in clinical denials or inpatient claims.
• Experience working with client-facing roles.
• Strong inpatient coding and DRG reimbursement knowledge.
• Experience with payer guidelines and hospital revenue cycle.
• Ability to lead cross-functional teams and manage priorities.
• Willing to travel 0-10%.

Responsibilities

• Acts as a subject matter expert in EnableComp Revenue Integrity related products, including DRG & DRGV, and Medical Necessity Denials & ED Downgrades.
• Define and establish departmental goals, financial targets, and KPIs aligned with company objectives.
• Assist in setting strategic direction of Revenue Recovery with senior leadership.
• Oversee development of quality and productivity metrics for Revenue Recovery.
• Lead training and rollout of process changes and best practices.
• Ensure processes and inventory to hit revenue expectations monthly, quarterly, and yearly.
• Responsible for hiring, staff training, and performance reviews.
• Coordinate resources to address action plans for clients and projects.
• Collaborate cross-functionally to guide planning, resource allocation, and partnerships.
• Set daily priorities to maximize impact and staffing alignment.
• Measure and report KPIs with corrective actions for variances.
• Explain variances to management regarding DRG reviews, billing activity, and revenue metrics.
• Research processes for improvements and SOP enhancements.
• Engage in high-level client relationships and ensure satisfaction with updates and escalations.
• Develop training materials and monitor trends to support onboarding and quality improvement.
• Build a high-performing team through leadership, coaching, and accountability.
• Maintain knowledge of regulatory/compliance requirements (HIPAA, coding guidelines).
• Maintain DRG coding, clinical documentation, and reimbursement knowledge.
• Other duties as required

Skills

Leadership

Healthcare reimbursement

DRG knowledge

KPIs & metrics

Client-facing

Education

Bachelors in HIM

Masters preferred

CCS/RHIT/RHIA

Job description

Job Responsibilities Include

• Acts as a subject matter expert in EnableComp Revenue Integrity related products, including DRG & DRGV, and Medical Necessity Denials & ED Downgrades).

• Define and establish departmental goals, financial targets, and key performance indicators that align with company objectives.

• Assists in setting the strategic direction of the Revenue Recovery and identifies areas of continuous improvement in conjunction with the senior leadership team.

• Oversee the development of quality and productivity metrics and benchmarks for Revenue Recovery functions based on industry standards and internal benchmarks.

• Acts as a key resource with the creation, communication, and training of process changes, and operational best practices within Revenue Recovery.

• Ensure the processes and inventory are in place to hit monthly, quarterly, and annual revenue expectations for the company.

• Responsible for hiring, staff training, and oversight, including annual goal planning, performance reviews, workload distribution, and regular monitoring of team performance. Ability to direct and motivate staff.

• Coordinate resources throughout the organization to address action plans for assigned clients and projects.

• Collaborate cross-functionally with other senior leaders to guide corporate planning, resource allocation, and strategic partnerships.

• Responsible for setting daily priorities to ensure the most impactful work is prioritized and appropriately staffed.

• Measures and monitors key performance metrics and delivers concise performance reporting to stakeholders with corrective action plans for variances when appropriate. Ensures these metrics are cascaded throughout the organization.

• Take the lead in explaining variances to management on a regular basis regarding DRG reviews, billing activity, and revenue metrics.

• Researches and analyzes operational processes and systems to identify process improvement opportunities and SOP enhancements.

• Participate in high-level client relationships and ensure client satisfaction through regular performance updates, collaboration, and resolution of escalated concerns.

• Oversee the development of training materials and evaluates trends to support onboarding, ongoing education, and quality improvement.

• Develops a high-performing team through effective leadership, coaching, and accountability to build a high-performing, scalable organizational structure.

• Maintain a current working knowledge of all related regulatory and compliance requirements (including HIPAA and coding guidelines) and ensures staff adherence through training, process updates, and policy alignment.

• Maintain a strong knowledge of DRG coding, clinical documentation, and reimbursement methodologies.

• Other duties as required

Requirements & Qualifications

• 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’ of progressive leadership experience in healthcare reimbursement, with 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.

• Demonstrated ability to operate effectively at both strategic and operational levels.

• Timely and regular attendance.

• Equivalent combination of education and experience will be considered

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Special Considerations & Prerequisites

• Practices and adheres to EnableComp’s Core Values, Vision and Mission.

• Travel 0-10%; general office environment

• Strong and professional written and oral communications skills.

• Has worked in a production environment and can meet deadlines. Provide examples of goals measurement for yourself and your team.

• Excellent people skills to interface with multiple internal stakeholders.

• Proven success in obtaining quantifiable results from and setting priorities for direct reports. Describe how you manage to individual goals.

• Organized and can handle multiple projects simultaneously.

• Health care experience and familiarity with payer or provider data sets.

• Ability to set and manage multiple priorities among several teams.

• Experience communicating obstacles & challenges and developing action plans to present to management. Provide examples.