Vice President, Revenue Integrity - DRG & DRGV Remote (anywhere in United States) + 1 more

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers’ Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years.

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, for the purpose of obtaining quantifiable results and setting priorities for direct reports. Leads dedicated product and service teams across Revenue Integrity to deliver best-in-class results to clients while ensuring clinical coding integrity and regulatory compliance. The VP possesses strong leadership and communication skills and reports regularly to senior management on obstacles, challenges, and opportunities that impact the Company’s revenue projections. The VP is accountable for developing and supporting leadership within the department, while driving operational performance, client satisfaction, and continuous improvement across Revenue Recovery.

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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.

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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.

EnableComp recruits, develops and retains the industry's top talent. As the employer of choice in the complex claims industry, EnableComp takes pride in our continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people. We believe that investing in our employees is the key to our success, and we are dedicated to providing them with the tools, resources, and support they need to thrive and grow their career here. At EnableComp, we are committed to living up to our core values each and every day, and we believe that this commitment is what sets us apart from other companies. If you are looking for a company that values its employees and is dedicated to helping them achieve their full potential, then EnableComp is the place for you.

Don’t just take our word for it! Hear what our people are saying:

“I love my job because everyone shares the same vision and is determined and dedicated. People care about you as a person and your professional growth. There is a genuine spirit of cooperation and shared goals all revolving around helping each other.” – Revenue Specialist

“I enjoy working for EnableComp because of the Core Values we believe in. EnableComp stands true to these values from empowering employees to ecstatic clients. This company is family oriented and flexible, along with understanding the balance of work, life, and fun.” – Supervisor, Operations