Executive Director, Revenue Integrity Operations

Role Description

The Executive Director, Revenue Integrity Operations provides systemwide leadership for charge capture, CDM governance & strategic pricing, revenue integrity edit management, and charge reconciliation across all Beth Israel Lahey Health (BILH) hospitals and affiliated entities. The Executive Director independently triages enterprise revenue integrity issues, directs cross-functional resolution efforts, ensures timely escalation and closure of systemic defects, and manages service levels for charge capture, edit resolution, and CDM operations. The Executive Director partners with hospital leaders, clinical departments, IT, Pricing, Finance, Compliance, and Revenue Cycle teams to drive resolution, eliminate root-cause issues, and ensure compliant, accurate revenue capture. (Remote)

Essential Duties & Responsibilities

• Oversight of Strategic Pricing Function:
  • Partner with the Strategic Pricing team to align charge structure, pricing methodologies, and CDM governance across the enterprise.
  • Ensure pricing changes are operationally executable, properly built into Epic systems, and reconciled through charge capture workflows.
  • Serve as an operational counterpart to Pricing leadership, ensuring downstream charge behavior, edits, and reimbursement impacts are monitored and addressed.
• Direct and independently manage the triage, routing, and resolution of enterprise revenue integrity issues including charging defects, workflow failures, systemic edit patterns, and payer requirement changes.
• Maintain ownership of issue escalation pathways and ensure timely closure with cross-functional coordination.
• Define, monitor, and manage service levels (SLAs) for charge posting timeliness, edit resolution, CDM turnaround, audit response, and charge reconciliation.
• Lead systemwide adoption of standardized charge capture workflows, reconciliation processes, and CDM governance practices.
• Provide operational direction to revenue integrity staff and partner teams across BILH to ensure consistent application of enterprise standards.
• Lead cross-functional workgroups to address charging issues, regulatory changes, Epic build impacts, and payer-driven charging requirements.
• Oversee day-to-day charge review, edit work queue management, prioritization, quality controls, and escalation pathways.
• Drive financial performance by ensuring accurate gross revenue capture and supporting net revenue optimization.
• Produce executive-ready reporting and analytics on charge capture, edit trends, and CDM performance.

Qualifications

• Bachelor’s degree required; Master’s degree preferred.
• Minimum of 10 years’ progressive experience in revenue integrity, charge capture, CDM governance, or revenue cycle operations, including multi-facility or systemwide leadership experience; strong leadership skills.
• Experience with Epic charge router logic, workflow optimization, and reporting tools.

Skills, Knowledge & Abilities

• Deep expertise in end-to-end charge capture workflows (hospital and professional billing).
• Strong command of edit logic, payer rules, and regulatory compliance.
• Advanced understanding of CDM structure, governance models, and pricing methodology.
• Ability to influence leaders across clinical, financial, and operational domains.
• Proven ability to prioritize and manage multiple complex issues in a high-volume environment.
• Demonstrated ability to independently manage complex issues and direct cross-organizational resolution efforts.

Preferred Qualifications & Skills

• Revenue Cycle or Analytics certifications preferred.

Key Business Relationships

• Hospital CFOs & Executive Directors – Ensure effective implementation of enterprise RI standards.
• Clinical Revenue Cycle Lead – Align on enterprise RI priorities and system performance.
• Revenue Cycle Business Partners – Communicate charge performance trends and triage barriers.
• Strategic Pricing & BILPN – Coordinate pricing structure and CDM changes with BILPN Contracting function.
• IT / Epic Application Teams – Drive build governance, testing, and operational readiness.
• Compliance & Internal Audit – Ensure regulatory adherence and audit readiness.

Physical Requirements & Environment

• Standard office environment; extensive computer use; ability to travel between sites as needed.

Pay Range

$180,000.00 USD - $210,000.00 USD

Equal Opportunity

Employer/Veterans/Disabled