Director, Revenue Integrity

Position Summary

As the lead of the Revenue Integrity team, the Revenue Integrity Director defines and carries out the strategy for maximizing gross and net revenue capture across the enterprise. The Director serves as the chief liaison between Revenue Cycle and clinical departments. The Director also ensures the availability and interpretation of reporting and analytics necessary for the clinical and Revenue Cycle departments to drive financial improvement.

Within the Revenue Integrity department, the Director oversees the following functions: charge capture, revenue reconciliation, Charge Description Master (CDM) and Charge Generation Tracker (CGT) maintenance, strategic pricing, contract management, payment validation, denial management and avoidable write‑off prevention, and reporting and analytics. They also serve as the ultimate escalation point for both the gross and net revenue streams. While HIM/Coding is not formally under the supervision of the Revenue Integrity Director, the Director will collaborate with the directors of HIM/Coding to ensure teamwork and knowledge share across teams to avoid duplicative or conflicting efforts.

The Director reports directly to the VP of Revenue Cycle.

• Lead the Revenue Integrity Department in an efficient and compliant manner, overseeing monitoring and improvement efforts within the functional areas of Revenue Integrity.

• Charge Capture – Ensure appropriate audit activities take place prior to and after billing to ensure accurate and optimal revenue capture and continually improve charging processes within departments.

• Revenue Reconciliation – Provide oversight of revenue reconciliation completed by operational and clinical leads across the enterprise, including the use of appropriate tools.

• CDM/CGT Management – Ensure the CDM/CGT is maintained, new codes are entered timely, and any pre‑bill edits are worked timely.

• Strategic Pricing – Provide oversight for annual price increases across the organization, understanding pricing goals and net impact of associated price increases.

• Contract Management – Oversee updates on performance, including risks to payor compliance with agreed‑to contract terms, and current process improvement initiatives.

• Payment Validation – Ensure accurate reimbursement by payors through internal processes and tertiary processes.

• Denial Management and Avoidable Write‑Off Prevention – Utilize data analytics to identify trends and work with functional areas for future prevention.

• Reporting and Analytics – Provide objective analysis through advanced reporting and interpretation of findings to support Revenue Integrity processes.

• Oversee all functions performed by the Revenue Integrity team, including analytics and reporting, communication with departments and external stakeholders, and ongoing strategy and development of the program.
• Work with the Revenue Integrity team to develop meaningful metrics and key performance indicators to drive strategic analysis and decision‑making.
• Lead targeted revenue improvement opportunities and assist with analyzing the financial impact as related to professional and hospital clinical departments.
• Work proactively with leadership within Revenue Cycle and Finance to prioritize areas of focus and ensure appropriate ongoing performance.
• Assist in the development and maintenance of appropriate controls and security of processes that lead to accurate clinical, operational, and financial operations.
• Act as liaison between HIM/Coding and Revenue Integrity to foster collaboration and ensure coordination of efforts between the teams, as appropriate.
• Uphold enterprise mission, vision, values, and ethical standards and demonstrate the behavioral and service expectations as defined in our policies and procedures.

• Bachelor's Degree in Business Administration, Health Care Administration, Clinical Administration, Finance, or related field required.

• Master's Degree preferred.

• Eight years of hospital Revenue Cycle, Revenue Integrity, and/or reimbursement experience are required, including seven years management experience with emphasis on project…