Director of Revenue Integrity

Job Description

Job Description

Description:

POSITION SUMMARY:

The Director of Revenue Integrity ensures the TGH Cancer Institute is billing accurately for the care it provides across surgical, radiation, medical oncology as well as supportive care services. This role leads the processes for charge capture, reconciliation and correct coding of all professional services provided. The Director works with clinical teams to resolve missed or inaccurate charge capture, insufficient documentation and identifies the causes of denied claims due to medical coding or documentation. The Director improves and designs system workflows, documentation optimization, and implements system rules to prevent recurring billing denials and support accurate, compliant claims processing.

CORE ESSENTIAL RESPONSIBILITIES:

• Lead revenue integrity across the TGH Cancer Institute, including charge capture, reconciliation, and coding processes.
• Establish and oversee workflows to identify and resolve missing, incorrect, duplicate, or delayed charges before claims are submitted.
• Oversee coding quality and timeliness, and partner with providers and clinical leaders to improve documentation that supports accurate, compliant billing.
• Analyze charge, coding, billing, and denial data; identify root causes and lead changes that prevent recurring errors and denials.
• Partner with Revenue Cycle, Clinical Operations, Patient Access, Compliance, IT, and Epic teams to define business requirements, test changes, and confirm that workflow and system updates to support accurate billing.
• Establish performance measures for charge capture, reconciliation, coding accuracy, clean claims, and preventable denials; report findings and recommended actions to leadership.
• Lead and develop assigned revenue integrity and coding staff, including setting expectations, evaluating performance, and addressing gaps.
• Ensure revenue integrity practices align with applicable billing regulations, payer requirements, and organizational policies.

REQUIRED EDUCATION & EXPERIENCE

• Bachelor’s degree in Healthcare Administration, Finance, Business, Health Information Management, or a related field.
• Minimum of 7 years of experience in revenue integrity with progressive experience in a complex healthcare system
• A minimum of 3 years in a leadership role.

REQUIRED CERTIFICATES, LICENSE OR REGISTRATION

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Revenue Cycle Representative (CRCR), or comparable certification.

REQUIRED KNOWLEDGE, SKILLS OR ABILITIES

• Knowledge of professional billing, coding, charge capture, and revenue cycle processes.
• Ability to analyze charge, billing, and denial data and identify the root causes of revenue leakage.
• Ability to lead initiatives involving access, clinical, operational, IT, and Revenue Cycle teams.
• Experience with Epic Resolute to include HB/PB billing workflows, charge router, charge reconciliation, charge review.