Vice President DRG

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging industry expertise and an intelligent automation platform to improve financial sustainability. The company serves hospitals, health systems, and ambulatory surgery centers nationwide, focusing on claims processing, denials management, and revenue optimization.

Location: Remote (US)

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 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 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.
• Act 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.
• 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 performance reports to stakeholders with corrective action plans for variances.
• Explain variances to management 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.
• Maintain knowledge of regulatory and compliance requirements (including HIPAA and coding guidelines) and ensure staff adherence.
• Maintain a strong knowledge of DRG coding, clinical documentation, and reimbursement methodologies.
• Other duties as required.

Requirements

• 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.
• Ability to perform each essential duty satisfactorily; reasonable accommodations may be made.