Vice President, Revenue Integrity - DRG & DRGV

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Vice President, Revenue Integrity – DRG & DRGV based in the United States.

The Vice President of Revenue Integrity will provide strategic leadership and operational oversight for revenue recovery initiatives focused on DRG and DRGV, clinical denials, medical necessity denials, and emergency department downgrades. This senior leadership role is responsible for driving financial performance, improving operational efficiency, and ensuring high-quality outcomes across revenue integrity functions. You will establish departmental goals, monitor key performance indicators, and lead initiatives that maximize revenue recovery while maintaining regulatory compliance. Working closely with executive leadership, cross-functional teams, and clients, you will align resources, strengthen service delivery, and support long-term business growth. The ideal candidate combines deep healthcare reimbursement expertise with strong people leadership and data-driven decision-making. This is an opportunity to shape strategy, develop high-performing teams, and deliver measurable results in a remote healthcare revenue cycle environment. \n

Accountabilities

Serve as a subject matter expert in revenue integrity services, including DRG and DRGV reviews, medical necessity denials, and emergency department downgrades.

Define departmental objectives, financial targets, productivity standards, and key performance indicators aligned with broader organizational goals.

Partner with senior leadership to establish the strategic direction of revenue recovery operations and identify opportunities for continuous improvement.

Develop and maintain quality, productivity, and performance benchmarks based on industry standards and internal operational data.

Ensure appropriate processes, staffing, and inventory management are in place to meet monthly, quarterly, and annual revenue expectations.

Lead workforce planning, recruitment, onboarding, training, performance reviews, goal setting, workload distribution, and ongoing performance management.

Establish daily priorities and allocate resources to ensure the highest-impact activities receive appropriate attention and staffing.

Monitor operational and financial performance, deliver clear reports to stakeholders, investigate variances, and implement corrective action plans where necessary.

Analyze DRG review outcomes, billing activity, and revenue metrics, communicating performance trends and variances to management.

Coordinate resources across departments to execute client action plans, manage projects, and resolve operational challenges.

Collaborate with senior leaders on corporate planning, resource allocation, strategic partnerships, and organizational development.

Build and maintain strong client relationships through regular performance updates, collaborative problem-solving, and timely resolution of escalated concerns.

Develop and enhance standard operating procedures, training materials, and process communications to support consistent execution, employee onboarding, and ongoing education.

Lead, coach, and motivate teams while establishing clear accountability, measurable goals, and a scalable organizational structure.

Maintain current knowledge of applicable healthcare regulations, HIPAA requirements, coding guidelines, and reimbursement standards, ensuring compliance through training, policies, and operational processes.

Evaluate systems, workflows, and operational data to identify improvement opportunities, strengthen quality, and increase revenue recovery effectiveness.

Perform additional duties as needed to support departmental and organizational objectives.

Requirements:

Bachelor's degree in health information management, nursing, healthcare administration, business, or a related field required; a master's degree is preferred.

Active Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA) credential strongly preferred.

7–10 years of progressive leadership experience in healthcare reimbursement, including at least 5 years in clinical denials or inpatient claims environments.

Strong expertise in inpatient coding, DRG reimbursement methodologies, medical record auditing, clinical documentation, and payer guidelines.

Experience working in hospital revenue cycle environments and using large-scale data analysis and reporting tools.

Demonstrated ability to operate effectively at both strategic and operational levels, translating business objectives into measurable results.

Experience working collaboratively with internal teams while maintaining client-facing or client-support responsibilities.

Proven success in setting goals, measuring team performance, prioritizing workloads, and achieving quantifiable results through direct reports.

Strong leadership, coaching, and people management skills, with the ability to motivate teams, build accountability, and support professional development.

Excellent written and verbal communication skills, including the ability to explain complex operational and financial issues to senior stakeholders and clients.

Strong analytical and problem-solving skills, with the ability to identify operational obstacles, evaluate performance trends, and develop actionable improvement plans.

Excellent organizational and project management abilities, including the capacity to manage competing priorities across multiple teams and initiatives.

Familiarity with healthcare data and payer or provider datasets, along with the ability to work effectively in a deadline-driven production environment.

Consistent attendance, reliability, sound judgment, and a professional approach to stakeholder relationships.

Willingness to travel approximately 0–10% as required. The position is remote, with occasional travel and work in a general office environment where needed.

Equivalent combinations of education and experience may be considered. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Benefits:

Remote work arrangement within the United States.

Full-time employment in a senior leadership role.

Opportunity to influence revenue integrity strategy, operational performance, and organizational growth.

Professional opportunity to lead specialized healthcare reimbursement and revenue recovery functions.

Specific salary range, healthcare coverage, retirement benefits, paid leave, and other compensation details are not specified in the source listing.

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