Vice President, Transformation Services – Denials Prevention

• Lead enterprise-wide denial prevention strategy and transformation across hospital revenue cycle operations




• Identify and quantify opportunities to improve revenue yield by preventing avoidable revenue leakage before claims are submitted




• Analyze denial, write-off, payer, and reimbursement data to identify root causes, emerging trends, and transformation opportunities




• Establish a denial prevention framework focused on upstream prevention and first-pass payment




• Develop prioritized transformation strategies based on financial impact, preventability, payer trends, operational performance, and implementation feasibility




• Drive performance toward industry benchmarks for denial rates, preventable denials, clean claims, write-offs, overturn rates, and first-pass payment




• Lead root-cause initiatives across Patient Access, Prior Authorization, Utilization Management, CDI, Coding, Revenue Integrity, Billing, Clinical Operations, and Payer Management




• Develop payer-specific prevention strategies addressing authorization, medical necessity, clinical validation, DRG downgrades, level of care, coding, timely filing, eligibility, and payment policy issues




• Identify payer behavior and policy changes and develop mitigation strategies




• Partner with Managed Care and payer relations teams on systemic payer issues, contractual opportunities, and payer escalation




• Define and monitor leading and lagging KPIs for denial outcomes and upstream prevention effectiveness




• Evaluate workflows and technology to move edits and interventions earlier in the revenue cycle




• Quantify transformation outcomes including net new revenue, avoided leakage, cash acceleration, reduced write-offs, and cost-to-collect improvement




• Partner with operational leaders to ensure strategies are implemented, adopted, measured, and sustained




• Develop standardized denial prevention methodologies, playbooks, benchmarks, and best practices across clients




• Support client assessments, business development, and executive presentations by articulating opportunities and financial value




• Foster continuous improvement, accountability, data-driven decision-making, and proactive revenue protection

Requirements

• 10 years of progressive leadership experience in Revenue Cycle Management and Denials work




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




• Proven experience in a leadership role within revenue cycle services, preferably in a healthcare hospital-based healthcare setting




• Strong understanding of revenue cycle management principles and practices, with a demonstrated ability to deliver high-quality services to clients




• Knowledge of state and federal governmental, legal, and regulatory provisions related to front-end, middle and backend revenue cycle operations




• Excellent leadership skills, including the ability to motivate, mentor, and develop a high-performing team




• Proficiency in revenue cycle management systems, electronic health records (EHR), and client management tools




• Ability to adapt to a fast-paced and changing environment, managing multiple priorities and deadlines effectively




• Proficiency in Microsoft Office Suite




• Strong interpersonal skills, ability to communicate well at all levels of the organization




• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses




• High level of integrity and dependability with a strong sense of urgency and results oriented




• Excellent written and verbal communication skills required




• Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes




• Ability to move around the work area; light lifting required; sit; perform manual tasks; operate tools and office equipment; extend arms; kneel; talk and hear




• Ability to follow directions, collaborate with others, and handle stress

Core Competencies

Demonstrates extensive expertise in Revenue Cycle Management and Denial Prevention, with a focus on developing and implementing strategies that enhance financial performance and operational efficiency. Proven ability to lead teams, analyze complex data, and drive continuous improvement in healthcare settings.

Highest-signal resume keywords

• Revenue Cycle Management




• Denial Prevention Strategy




• Leadership in Healthcare




• Data Analysis and Transformation




• KPI Monitoring and Evaluation

ATS Optimization Keywords

Hard Skills

• Revenue Cycle Management Principles




• Denial Analysis




• Financial Impact Assessment




• Payer Behavior Analysis




• Regulatory Compliance Knowledge




• EHR Proficiency




• Client Management Tools




• Transformation Strategy Development




• Performance Benchmarking




• Denial Prevention Methodologies

Soft Skills

• Leadership Skills




• Interpersonal Communication




• Problem Solving
  
• Creative Thinking




• Team Development

Industry Keywords

• Healthcare Administration




• Denials Management




• Patient Access




• Utilization Management




• Clinical Documentation Improvement (CDI)




• Coding




• Billing




• Payer Relations




• Contractual Opportunities




• Continuous Improvement

Tools & Technologies

• Microsoft Office Suite




• Revenue Cycle Management Systems




• Electronic Health Records (EHR)