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.