System Director, Revenue Integrity
Enterprise leadership for charge capture, CDM governance, revenue assurance,
compliance, and clinical revenue cycle integration.
Position Details
Remote
You must reside in one of these states to be eligible for this position:
Arkansas California Kentucky
Massachusetts Nevada New Mexico
Oregon Utah Tennessee
Texas Wyoming
Position Summary
The System Director, Revenue Integrity leads the health system's enterprise
Revenue Integrity function and sets the strategy, governance, controls, and
operational infrastructure needed to ensure complete, accurate, compliant, and
timely revenue capture across the organization.
This executive serves as the system's leader for charge capture, chargemaster
(CDM) governance, clinical revenue cycle integration, revenue leakage
prevention, reimbursement compliance, and Revenue Integrity performance. The
Director partners closely with Finance, Revenue Cycle, Clinical Operations,
Coding/HIM, Compliance, Information Technology, Supply Chain, Pharmacy, and
hospital leadership to ensure that clinical activity is accurately translated
into compliant and collectible revenue.
The role provides enterprise oversight across all hospitals, ambulatory
locations, professional services, ancillary departments, and other applicable
business units. The Director also leads the continued development and maturation
of the Revenue Integrity operating model, including organizational structure,
policies, governance, technology, analytics, education, auditing, and
performance management.
Key Responsibilities
Enterprise Revenue Integrity Strategy and Leadership
Develop and execute the health system’s enterprise Revenue Integrity
strategy, operating model, and multi-year roadmap.
Establish standardized Revenue Integrity policies, procedures, controls, and
governance across hospitals and business units.
Define clear accountability for charge capture, charge reconciliation,
chargemaster maintenance, documentation, coding, and revenue-related
operational processes.
Serve as the executive subject matter expert for Revenue Integrity and advise
senior leadership on compliance risk, revenue opportunity, operational
performance, and strategic priorities.
Lead the development and continued maturation of the enterprise Revenue
Integrity organizational structure.
Build and maintain strong working relationships with hospital presidents,
CFOs, COOs, clinical executives, Revenue Cycle leadership, Compliance, IT,
HIM, Coding, Pharmacy, Supply Chain, and departmental leaders.
Charge Capture and Revenue Assurance
Provide enterprise oversight of charge capture processes across hospital,
professional, ambulatory, procedural, diagnostic, pharmacy, supply, implant,
and ancillary services.
Develop standardized charge reconciliation processes to ensure services
rendered are reflected on patient accounts accurately and on time.
Establish controls to identify missing, duplicate, delayed, inaccurate, or
unsupported charges.
Partner with clinical departments to integrate appropriate charging processes
into operational and clinical workflows.
Develop processes for monitoring late charges, manual charges, charge
corrections, charge lag, and other indicators of revenue leakage or process
failure.
Establish departmental ownership and accountability for charge capture
performance.
Chargemaster and Fee Schedule Governance
Provide executive oversight of hospital chargemasters (CDMs), professional
fee schedules, charging dictionaries, and related reference files.
Establish enterprise CDM standards for CPT and HCPCS assignment, revenue
codes, modifiers, pricing, charge descriptions, charge logic, and billing
configuration.
Develop formal processes for ongoing CDM maintenance, annual and quarterly
code updates, regulatory changes, new services, new technology, and charge
requests.
Ensure consistent charging methodologies across hospitals and service lines
where clinically and operationally appropriate.
Establish governance for requests to add, modify, deactivate, or otherwise
change chargeable services.
Partner with Finance and executive leadership on pricing strategy, gross
charge methodologies, and compliance with hospital price transparency
requirements.
Revenue Integrity Audit and Revenue Leakage Prevention
Develop a comprehensive enterprise Revenue Integrity audit and monitoring
program.
Identify and address missing charges, incorrect charges, coding
discrepancies, documentation deficiencies, billing errors, payer issues, and
reimbursement variances.
Establish risk-based audit priorities using financial, operational,
regulatory, and utilization data.
Ensure identified issues result in documented corrective action and follow-up
monitoring, supported by education, workflow remediation, or system changes
as needed.
Quantify and report financial opportunities, recoveries, prevented revenue
leakage, and compliance-related findings.
Establish repeatable processes for validating that corrective actions remain
effective over time.
Regulatory, Coding, and Reimbursement Compliance
Monitor changes in CMS, state, and other regulatory requirements, AMA coding
guidance, and commercial payer policies that affect charging, coding,
reimbursement, and billing.
Ensure regulatory changes are translated into operational, system, and CDM
updates throughout the organization.
Partner with Compliance, Coding, HIM, and Legal as appropriate to interpret
and operationalize complex billing and reimbursement requirements.
Promote compliant charging practices while supporting appropriate and
complete reimbursement for services provided.
Ensure Revenue Integrity activities are appropriately coordinated with
Coding, Clinical Documentation Integrity, Billing, Denials, Contracting, and
Compliance functions.
Clinical and Operational Revenue Cycle Integration
Partner with clinical and operational leaders to improve the accuracy and
reliability of charge capture at the point of care.
Develop service-line-specific Revenue Integrity strategies for high-risk or
high-value areas such as Surgery, Cardiology, Cath Lab, Interventional
Radiology, Emergency Services, Pharmacy, Infusion, Imaging, Laboratory,
Rehabilitation, and Oncology, as well as supply and implant charging.
Establish processes to incorporate Revenue Integrity review into new service
development, new technology implementation, departmental workflow redesign,
and capital planning.
Educate clinical and operational leaders on their role in revenue capture and
billing compliance.
Promote an organizational culture in which Revenue Integrity is viewed as a
shared operational responsibility rather than solely a back-end Revenue Cycle
function.
Technology and EHR Optimization
Partner with Information Technology and application teams to ensure EHR and
revenue cycle systems support accurate, efficient, and compliant charge
capture.
Provide Revenue Integrity leadership for major EHR implementations,
conversions, upgrades, and optimization initiatives.
Oversee business requirements related to charging workflows, charge routers,
automated charging, interfaces, preference lists, order-to-charge logic,
supply charging, pharmacy charging, professional charge capture, and related
revenue cycle functionality.
Ensure charging logic and CDM configuration are appropriately tested before
implementation.
Establish governance for system configuration changes that affect charging,
billing, or reimbursement.
Promote automation and exception-based workflows where appropriate to reduce
manual intervention and improve accuracy.
Analytics and Performance Management
Develop an enterprise Revenue Integrity performance framework and executive
dashboard.
Establish key performance indicators related to charge capture, charge lag,
late charges, reconciliation completion, CDM accuracy, audit findings,
financial opportunity, corrective action, and departmental performance.
Use analytics to identify trends, outliers, risks, and opportunities across
hospitals and service lines.
Establish transparent reporting to senior leadership and operational
stakeholders.
Develop departmental scorecards and accountability mechanisms where
appropriate.
Track financial value generated through Revenue Integrity initiatives,
including recovered revenue, prevented leakage, process improvement, and risk
mitigation.
Organizational Development and Education
Recruit, develop, and retain a high-performing Revenue Integrity leadership
and technical team.
Establish clear roles and responsibilities across enterprise and local
Revenue Integrity resources.
Develop career pathways and succession planning within the Revenue Integrity
function.
Establish competency standards for Revenue Integrity staff.
Develop an enterprise education program for Revenue Integrity employees,
clinical departments, operational leaders, and other stakeholders.
Promote ongoing professional development and relevant certifications.