Vice President, Revenue Integrity - DRG & DRGV

Position Summary

The VP, Revenue Integrity is responsible for providing leadership and supervision to the Revenue Recovery products under the Denials umbrella, including Diagnosis-Related Group (DRG & DRGV), and Medical Necessity Denials and Emergency (ED) Downgrades. The VP leads dedicated product and service teams across Revenue Integrity, drives operational performance, client satisfaction, and continuous improvement, and reports regularly to senior management on obstacles, challenges, and opportunities that impact the Company’s revenue projections.

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.
• Assist in setting the strategic direction of the Revenue Recovery and identify areas of continuous improvement in conjunction with senior leadership.
• Oversee the development of quality and productivity metrics and benchmarks for Revenue Recovery functions based on industry standards and internal benchmarks.
• Act as a key resource with 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.
• Responsible for hiring, staff training, and oversight, including annual goal planning, performance reviews, workload distribution, and regular monitoring of team performance.
• 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.
• Measure and monitor key performance metrics and deliver concise performance reporting to stakeholders with corrective action plans for variances when appropriate.
• Take the lead in explaining variances to management on a regular basis regarding DRG reviews, billing activity, and revenue metrics.
• Research and analyze 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 evaluate trends to support onboarding, ongoing education, and quality improvement.
• Develop a high‑performing team through effective leadership, coaching, and accountability to build a scalable organizational structure.
• Maintain a current working knowledge of all related regulatory and compliance requirements, including HIPAA and coding guidelines, and ensure 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 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.

EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment.