Director, Revenue Integrity

Title: Director Revenue Integrity

Reports to: VP, Credentialing and Billing

Classification: Director

Location: Boston (Hybrid)

Job description revision number and date: V4.0; 12.12.2025

Organization Summary

Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices in Massachusetts and across the country.

We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.

Job Summary

This role requires a detail-oriented professional with experience in coding, billing, reimbursement, and payer requirements to ensure accurate and compliant revenue capture with operational efficiency throughout the process of documenting the service, billing, and collecting on services provided. The Revenue Integrity Director will lead efforts to optimize revenue cycle processes, maintain coding accuracy, and ensure compliance with payer and regulatory requirements.

Functional area

s of responsibility include Charge Description Master (“CDM”) maintenance, charge capture and reconciliation related functions, payment variance, audit and appeals management. This position closely collaborates with the Billing/Accounts Receivable Manager particularly around claim form logic, denials management, and audit reviews. Confirms that metrics are met, charge entry rates and accuracy rates are achieved to meet yearly revenue goals. This role is particularly suited for an Epic-certified revenue cycle leader with extensive expertise in implementing, optimizing, and supporting end-to-end billing workflows, especially within FQHCs or complex multi-site organizations.

The Director will utilize deep knowledge of Epic Resolute Professional Billing, Claims, Remittance, charge review work queues, payer configuration, and testing leadership to guarantee that all revenue integrity functions operate with precision, efficiency, and regulatory compliance.

Responsibilities

• Lead and mentor the revenue integrity team, providing guidance and support to achieve departmental goals
• Develop training programs focused on documentation standards, Epic workflows, coding accuracy, and payer compliance
• Promote a culture of collaboration, accountability, innovation, and continuous improvement
• Contribute to shaping the vision for C3 as the preferred resource for an affordable and efficient MSO in Billing and Credentialing
• Oversee revenue integrity operations to ensure accurate charge capture, compliant coding, and billing practices
• Ensure compliance with federal and state regulations, including FQHC-specific guidelines and Massachusetts healthcare requirements
• Conduct audits of coding, documentation, and charge routing, implementing corrective actions to eliminate recurring issues
• Regularly review payer contracts, reimbursement policies, and updates to billing codes (e.g., CPT, ICD-10, HCPCS)
• Collaborate with clinical and operational teams to ensure services are accurately documented and coded
• Monitor charge capture processes to identify and resolve discrepancies
• Works and monitors assigned charge capture WQs to resolve discrepancies and facilitate timely claims submission
• Identify new revenue opportunities based on updated regulations, understanding of services provided, and documentation/chart review to support additional revenue capture
• Implement quality assurance measures to enhance revenue integrity
• Ensure proper coding practices across all departments, including training and support for coding staff
• Conduct regular audits of coding and documentation to identify and address errors
• Maintain expertise in coding standards and provide guidance on updates or changes
• Serve as the primary liaison for EPIC-related revenue integrity processes, ensuring optimal system configuration and utilization
• Utilize…