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Hospital & Health Care

Director System Revenue Integrity

Hyannis, MAOnsiteFull TimeDirectorPosted 1 month agoVisa sponsorship available

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Required skills

  • Revenue Integrity
  • KPIs
  • Charge Capture
  • Revenue Leakage
  • Internal Audits
  • CDM
  • Regulatory Compliance
  • Payer Requirements
  • Denial Management
  • Appeals

Nice to have

  • Major Healthcare Consulting Firm

Role summary

The Director System Revenue Integrity will lead the establishment and implementation of KPIs for revenue integrity functions, ensuring performance meets expectations and driving continuous improvement. This role involves developing and overseeing operational policies, processes, and tools to identify and minimize revenue leakage through charge capture improvements, proactive audits, and technology enablers. The Director will ensure CDM compliance, manage denial management processes, and oversee payment variance analysis and reporting. This leadership position requires strong analytical, critical-thinking, and business process optimization skills, with a minimum of 5-7 years of relevant experience in a complex healthcare organization and 3-5 years of supervisory/management experience.

  1. Lead the establishment and implementation of Key Performance Indicators (“KPIs”) for revenue integrity functions;
    ensure the implementation of action plans where performance is not meeting expectations; review KPI expectations
    annually and adjust appropriately; recognize areas of excellence.
  2. Develop, implement, and oversee effective and consistent operational policies, processes, tools, and educational
    materials within all Revenue Integrity functional areas.
  3. Oversee the operational performance of a system-wide, service line-based Charge Review program dedicated to
    identifying charge capture issues/improvement opportunities to minimize revenue leakage, through the use of technology
    enablers and proactive internal audits/reviews of charging practices.
  4. Ensure that the CDM is compliant with regulatory and payer requirements and that all services provided have an
    established charging and reconciliation methodology.
  5. Ensure Revenue Integrity employees across all functions comply with established policies, processes, and quality
    assurance programs.
  6. Identify potential process improvements in charge capture functions, and lead the design and implementation as
    required.
  7. Monitor and facilitate service level agreements (“SLAs”) between Revenue Integrity operations and other related
    functions within both Revenue Cycle and Clinical operations. This includes confirmation that charge review queues/
    requests are managed appropriately.
  8. Build strong relationships and facilitate productive communication between key Revenue Cycle stakeholders, including
    peer leaders of Revenue Cycle services and core support departments (e.g., human resources, IT, finance).
  9. Develop, implement, and manage efficient and effective operational policies, procedures, processes and performance
    monitoring across all revenue integrity functions.
  10. Ensure audit of denial management processes occurs consistently and coordinate with peers across the revenue cycle
    organization, and with other related stakeholders, to identify trends and implement denial prevention/recovery programs.
  11. Oversee, measure, and report ongoing financial and operational performance of Revenue Integrity, audit and appeals
    outcomes and denial management across CCHC.
  12. Support CCHC strategic initiatives that require involvement from revenue integrity functions as required.
  13. Assess direct reports’ performance on a consistent basis and provide feedback to reward effective performance and
    enable proactive performance improvement steps to be taken.
  14. Lead the establishment and implementation of Key Performance Indicators (“KPIs”) for audit and appeal functions;
    ensure the implementation of action plans where performance is not meeting expectations; review KPI expectations
    annually and adjust appropriately; recognize areas of excellence.
  15. Develop reporting to support the transparency of audit and appeals outcomes
  16. Identify potential process improvements within the audit and appeals workflows and lead the design and
    implementation as required.
  17. Develop and monitor productivity metrics for all Revenue Integrity functional areas
  18. Oversees payment variance team members and workflows
  19. Seeks opportunities to address and remedy system and/or payer related issues causing payment variances
  20. Develop reporting to identify and monitor root cause payment variance issues
  21. Reports payment variances to executive leadership
  22. Challenges current working practices; identifies process improvement opportunities and presents recommendations
    and solutions to management. Engages and commits to the organization’s culture of continuous improvement by
    actively participating, supporting, and promoting CCHC Pillars of Excellence.


  • Bachelor's degree in Business Administration, Healthcare Management or related discipline and or equivalent
    experience.
  • Minimum of five to seven years of relevant experience with a track record of progressively responsible positions in a
    complex healthcare organization such as a multi-hospital system, large group practice or a major healthcare consulting
    firm preferred. 
  • Minimum of three to five years of supervisory/management experience.
  • Strong working knowledge of billing and collection processes and functions, charging processes and general revenue
    cycle management strategies, and industry best practices.
  • Thorough knowledge of metrics, analytics, and data synthesis in healthcare revenue integrity and revenue cycle
    management to identify trends, produce reliable forecasts and projections.
  • Strong analytical and critical-thinking, organizational, and business process optimization skills, with in-depth ability to
    develop and pursue goals, synthesize data to identify system vulnerabilities and develop and apply innovative solutions.
  • Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the
    general public.
  • An understanding of the psychology of complex corporate relationships, and an ability to influence within such an
    environment.
  • Excellent communication, leadership, delegation, and interpersonal skills.
  • Above average understanding of how, when, and to what extent different hospital departments relate to and
    communicate with one another.
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