Director, Revenue Integrity

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.