VP, Denials Prevention & Revenue Transformation

Med-Metrix; Parsippany-Troy Hills (NJ); Hybrid; USD 180,000 - 250,000; Full time

Job summary

Med-Metrix seeks a VP, Transformation Services - Denials Prevention to lead enterprise-wide initiatives that reduce denials, protect revenue, and raise revenue cycle performance for health system clients. You will leverage analytics, payer insights, and root-cause analysis to stop revenue leakage upstream in the revenue cycle.

Partner with client executives and internal teams to implement prevention strategies, set KPIs, and drive sustainable improvements toward top-tier benchmarks and reduced

Qualifications

• 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 healthcare hospital-based.
• Knowledge of state and federal regulatory provisions related to front-end and back-end revenue cycle operations.
• Strong leadership, mentor ability, and team development.

Responsibilities

• Lead enterprise-wide denial prevention strategy and transformation across hospital revenue cycle operations.
• Identify and quantify opportunities to prevent avoidable revenue leakage before claims are submitted.
• Analyze denial, write-off, payer, and reimbursement data to identify root causes and trends.
• Establish a comprehensive denial prevention framework focusing on upstream prevention and first-pass payment.
• Develop prioritized transformation strategies based on impact, preventability, and feasibility.
• Drive performance toward top-tier industry benchmarks for denial metrics and clean claim performance.
• Lead cross-functional initiatives across Revenue Cycle segments and Payer Management.
• Develop payer-specific prevention strategies addressing authorization, medical necessity, and coding issues.
• Identify payer behavior changes and mitigations before revenue impact.
• Partner with Managed Care to identify systemic payer issues and trends.
• Define KPIs that measure denial outcomes and prevention effectiveness.
• Evaluate workflows and technology to move edits earlier in the revenue cycle.
• Quantify transformation outcomes including net revenue and cash acceleration.
• Collaborate with operational leaders to implement and sustain strategies.
• Develop standardized denial prevention methodologies and playbooks.

Skills

Leadership & strategy

Communication

Problem solving

Project management

Analytical skills

Education

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

Tools

Revenue Cycle Systems

EHR (Electronic Health Records)

MS Office Suite

Job description

Med-Metrix seeks a VP, Transformation Services - Denials Prevention to lead enterprise-wide initiatives that reduce denials, protect revenue, and raise revenue cycle performance for health system clients. You will leverage analytics, payer insights, and root-cause analysis to stop revenue leakage upstream in the revenue cycle.

Partner with client executives and internal teams to implement prevention strategies, set KPIs, and drive sustainable improvements toward top-tier benchmarks and reduced