VP, Clinical Revenue Cycle

Job description

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team. Job Summary The Vice President (VP) of Clinical Revenue Cycle is a senior executive leader accountable for the strategy, performance, and operational excellence of middle revenue cycle functions across a large, multi-hospital health system. The role provides enterprise oversight or coordination of Health Information Management (HIM), Clinical Documentation Integrity/Improvement (CDI), hospital (HB Coding) and professional coding (PB Coding) operations, charge capture and revenue integrity (RI) including Charge Description Master (CDM) governance, pricing strategy, and related clinical-to-financial processes that translate patient care into accurate, compliant claims and appropriate reimbursement. This role ensures high standards of documentation and coding quality, strong regulatory compliance, and audit readiness while driving measurable improvement in case mix index (CMI) revenue integrity, DNFB & CFB performance, claim quality, denial prevention, and maximizing net revenue realization. This role will partner closely with clinical leadership, quality, the physician enterprise, utilization review and management, compliance, front-end patient access, back-end patient financial services, managed care and finance to standardize workflows, reduce variation, and enable scalable performance through technology, analytics, and talent development. This position reports directly to the SVP Revenue Cycle. Job Description Minimum Qualifications Education : Bachelor’s degree in Business Administration, Finance, Accounting, Healthcare Administration, Health Information Management, or related field (or equivalent combination of education and experience) required. The Master’s degree (MBA, MHA, MPH, MS-HIM, or related) preferred. Licenses/Certifications: Professional credentials such as RHIA, RHIT, CCS, CCS-P, CPC, CRC, CDIP, CCDS, RN, or demonstrable experience overseeing mid-cycle operations including HIM, Coding, CDI, and Revenue Integrity Experience with enterprise EHR and revenue cycle platforms (e.g., Epic) and coding/encoder/CAC technologies. Lean/Six Sigma or comparable process improvement training and application in complex operations. Experience/Knowledge/Skills: Deep understanding of middle revenue cycle interdependencies: clinical documentation, coding, charge capture, claim quality, denial prevention and reimbursement accuracy. Strong working knowledge of inpatient and outpatient reimbursement and coding rules (e.g., ICD-10-CM/PCS, CPT/HCPCS, MS-DRG/APC concepts, NCCI edits, modifier usage, medical necessity documentation). Demonstrated ability to create enterprise governance, standardize workflows, and establish clear performance accountability in a matrixed environment. Proven change leadership including workflow redesign, operational transformation, and technology enablement (EHR optimization, encoder/CAC tools, automation, and analytics). Progressive leadership experience in middle revenue cycle functions (e.g., HIM, CDI, coding operations, charge capture/revenue integrity) within a complex healthcare delivery system. Demonstrated knowledge of federal and state regulations and payer requirements impacting documentation, coding, billing, and reimbursement (e.g., CMS guidance, OIG compliance expectations). Demonstrated knowledge of quality and payment- related program measurement, reporting, and public ratings systems. Proven ability to lead multi-site teams and drive transformation with measurable outcomes (quality, throughput, compliance, and financial performance). Data-driven performance management skills; ability to define KPIs, build dashboards, and translate trends into prioritized action plans. Strong communication and influence skills with physicians, clinical leaders, finance, compliance, and operational stakeholders; able to drive alignment across competing priorities. Experience leading internal and external audits, building corrective action plans, and sustaining compliance monitoring processes. People leadership capabilities including talent development, succession planning, and building high-performing teams across multiple sites. Ability to travel across the enterprise including the different hospital sites as needed. Principal Accountabilities Establish and execute the enterprise middle revenue cycle strategy (HIM, CDI, HB/PB coding, CDM, charge capture, and revenue integrity) aligned to system financial goals, compliance standards, and patient/clinical experience objectives. Design and lead an operating model that standardizes policies, workflows, role clarity, productivity expectations, and quality controls across hospitals and employed physician groups; reduce variation and improve scalability. Provide executive oversight of enterprise CDI, including program design, staffing, prioritization, and performance outcomes; partner with physician leadership to improve documentation quality and compliant severity capture. Ensure enterprise‑wide coding excellence across inpatient, outpatient, and professional services by setting strategy and oversight for coding operations, workforce competency frameworks, quality auditing, and vendor performance management. Own end-to-end DNFB and CFB drivers associated with documentation, coding, and charge capture; set targets and lead interventions to improve throughput, minimize backlogs, and stabilize operations during surges and change events. Facilitate the optimization and accuracy for quality measurement programs (eCQMs, AHRQ indicators, CAHPS surveys, Vizient), quality reporting programs (IQR, OQR, specialty QR programs), and payment & ratings systems (HVBP, HRRP, HACRP, and Star Ratings / Care Compare). Lead enterprise revenue integrity and charge capture strategy (including charge governance and controls as applicable) to prevent charge leakage, ensure accurate charging, and strengthen pre-bill controls that improve claim quality. Provide enterprise oversight of Charge Description Master (CDM) governance and pricing strategy, partnering with Managed Care, Revenue Integrity, and Finance to ensure compliant charge structures, accurate reimbursement modeling, and alignment to payer contract terms. Partner with Patient Financial Services and denials teams to reduce preventable denials through upstream interventions (documentation, coding, charging, edits); drive sustained improvement via root-cause management and standard work. Support enterprise payer contracting governance by collaborating with Managed Care on contract design considerations and providing middle revenue cycle input to mitigate documentation, coding, and charging risk across contracted services. Ensure audit readiness and regulatory compliance for documentation, coding, and charging; oversee internal/external audit responses, manage corrective action plans, and maintain monitoring processes in collaboration with Compliance/Legal. Develop and maintain KPI dashboards and executive reporting (e.g., coding turnaround time, quality scores, query metrics, CMI integrity, edit/clean claim rates, charge lag, denial trends); translate insights into action plans. Lead technology enablement and optimization with IT and operational leaders (EHR build, CAC/encoder tools, workflow automation, reporting/analytics); ensure design supports compliant, efficient clinical-to-claim workflows. Ensure a consistent middle revenue cycle operating model across academic medical centers, community hospitals, and employed physician groups, while enabling appropriate local workflow variation. Build, mentor, and retain high-performing teams; establish clear goals, performance expectations, and succession plans across HIM, CDI, coding, and revenue integrity leaders. Facilitate the adoption of automation to improve efficiency, effectiveness, and accuracy. Manage budgets, staffing plans, and vendor performance; define and track ROI for initiatives and technology investments. Ensures safe care for patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service. Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff. Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards of providing safe, caring, personalized and efficient experiences to patients and our workforce. Other duties as assigned. Key Collaboration Partners Chief Revenue Officer / Chief Financial Officer and Revenue Cycle senior leadership (Patient Access, PFS/Collections, Managed Care). Hospital and ambulatory operations leadership; service line and ancillary department leaders responsible for charge capture workflows. Physician enterprise leadership, Medical Staff leadership, and physician advisors/clinical champions. Clinical leadership (CNOs, CMOs), Case Management/Utilization Management, Quality, and Care Management teams. Compliance, Privacy/Legal, Internal Audit, and external auditors/payers as needed. Health IT / Informatics, Analytics, and Revenue Cycle applications teams (EHR, CDI/coding tools, reporting). Third-party vendors/partners supporting coding, HIM/ROI, CDI, audit, and technology solutions. Performance Metrics DNFB performance: total dollars and days attributable to documentation, coding, and charge capture; backlog aging and throughput by facility and service line. Coding turnaround time and productivity (inpatient/outpatient/professional), including quality audit scores and rework rates. CDI effectiveness: query volume, response rate and timeliness, agreement rate, documentation quality indicators, and CMI integrity measures. Charge capture performance: charge lag, charge reconciliation accuracy, charge correction volumes, and leakage prevention results. Claim quality: edit/work queue volumes, clean claim rate, and percent of claims requiring rework due to coding/documentation/charge issues. Denial prevention outcomes: denial rate and dollars tied to documentation/coding/medical necessity/charging, appeal overturn rates where applicable, and recurring root-cause reduction. Audit readiness: external and internal audit findings, repayment/adjustment trends, timeliness of corrective action completion, and sustained compliance monitoring results. People and service metrics: turnover, vacancy rate, training completion, engagement, vendor SLA performance, and stakeholder satisfaction.