Director, Revenue Integrity

Overview

The Director of Revenue Integrity provides enterprise-wide leadership over charge capture, revenue integrity edit operations, chargemaster (CDM) operations, and charge/revenue reconciliation across all facilities and service lines. This leader is accountable for establishing standardized policies, decision rights, and internal controls that reduce variation, prevent revenue leakage, and maintain audit-ready compliance through disciplined build/change management, proactive monitoring, and closed-loop issue resolution. The Director partners withclinical departments, Finance, Compliance, Information Technology (IT), Coding, Billing, Follow-Up, and RCM Business Support to strengthen governance, reporting, and execution — delivering measurable net revenue protection and enterprise standardization.

Qualifications

Education: Bachelor’s degree in Healthcare Administration, Finance, Business, or a related field required .

Master’s degree (e.g., MHA, MBA) preferred.

• Experience: Minimum of 7 to 10 years of progressive leadership experience in healthcare revenue cycle, revenue integrity, or related functions.
• Demonstrated experience leading:
• Revenue Integrity operations
• Charge capture programs
• Chargemaster (CDM) management
• Related revenue cycle functions in a complex healthcare environment
• Experience working within hospital revenue cycle operations.
• License/Certification/Registration: Preferred certifications include:
• CHRI (Certified Healthcare Revenue Integrity Professional)
• CCS (Certified Coding Specialist)
• CPC (Certified Professional Coder)
• CRCR (Certified Revenue Cycle Representative)
• RHIA (Registered Health Information Administrator)
• RHIT (Registered Health Information Technician)
• CHC (Certified in Healthcare Compliance)
• Demonstrated expertise in:
• Team leadership and talent development
• Coaching and succession planning
• Building high-performing teams
• Executive-ready communication skills, including:
• Written communication
• Verbal communication
• Facilitation and presentation skills
• Executive stakeholder engagement
• Strong change leadership capabilities with a continuous improvement mindset.
• Demonstrated performance management discipline, including:
• Key Performance Indicators (KPIs)
• Operational cadence
• Accountability frameworks
• Experience providing enterprise governance and decision-making leadership for:
• Charge capture processes
• Revenue integrity edits
• Chargemaster (CDM) standards
• Revenue cycle controls
• Proven ability to influence and collaborate across:
• Clinical operations
• Finance departments
• Compliance teams
• Revenue cycle leadership
• Operational stakeholders
• Strong skills in:
• Data-driven prioritization
• Structured problem solving
• Revenue leakage prevention
• Operational optimization
• Ability to navigate escalations and complex issues within matrixed healthcare organizations.
• Experience building closed-loop feedback mechanisms between upstream and downstream revenue cycle teams.
• Deep expertise in:
• Charge capture workflows
• Revenue integrity operating models
• Facility and service-line revenue processes
• Strong understanding of:
• Revenue integrity edit concepts
• Pre-bill edit operations
• Defect identification and triage
• Root-cause analysis and resolution methodologies
• Knowledge of reimbursement methodologies and the impact of charge structure on:
• Billing accuracy
• Claim edits
• Reimbursement outcomes
• Payment optimization
• Demonstrated experience with Chargemaster (CDM) management.
• Working knowledge of:
• National Correct Coding Initiative (NCCI) edits
• Charge and coding compliance concepts
• Revenue cycle regulatory requirements
• Revenue integrity best practices
• Strong technology fluency with experience using:
• EHR charge build tools
• Chargemaster (CDM) and pricing repositories
• Reconciliation and variance analytics tools
• Revenue cycle reporting platforms
• Operational dashboards and analytics solutions
• Strong analytical, operational, compliance, and leadership skills with a focus on revenue optimization, governance, regulatory compliance, and continuous process improvement.