Associate Director Revenue Integrity

About This Role

This role will provide operational oversight to the Revenue Integrity Analyst team, focusing on revenue optimization through charge capture integrity, education, and compliance with regulatory agencies. The Associate Director will lead process changes, mentor team members, and troubleshoot issues to ensure compliant revenue capture.

Responsibilities

• Monitor and trend financial data related to charge capture progress, identify variances, and implement process improvements for compliant revenue optimization.
• Provide operational oversight of revenue integrity staff and serve as a liaison between Revenue Integrity and clinical/operational departments.
• Develop, educate, and manage Revenue Integrity Specialists in analyzing, communicating, and educating hospitals and clinics on deficient charging trends and corrective actions.
• Engage with clinical areas and revenue cycle departments to confirm billable items and services are charged appropriately and timely.
• Provide revenue integrity recommendations and updates to the Revenue Integrity Steering Committee, confirming appropriate actions are carried out.
• Maintain current knowledge of regulatory changes impacting charge practices and develop charge capture/reconciliation policies and procedures.
• Implement charge capture review programs for hospital revenue-generating departments.
• Manage charge reviews to ensure annual coding changes and new service lines are incorporated correctly into the charge master.
• Work independently under limited supervision, making independent judgments based on specialized knowledge.
• Hold system-wide responsibility for managing the company’s charge capture, charge reconciliation, and chart reviews related to charging issues.

Requirements

• Bachelor’s degree in business, healthcare administration or equivalent work experience
• 5+ years recent experience in Revenue Integrity
• At least 2 years of experience within leadership role, including performance management of direct reports
• Strong knowledge of ICD/DRG coding and/or CPT coding principles
• In-depth knowledge of medical terminology, anatomy and physiology
• Thorough understanding of clinical record content and coding conventions/reimbursement guidelines across all service lines, LCD/NCDs and MAC/FIs
• Extensive critical and analytical thinking skills
• Ability to organize workload to meet deadlines and maintain confidentiality
• Ability to research, interpret, and develop recommendations
• Excellent written and oral communication skills

Qualifications

• Bachelor’s degree in business, healthcare administration or equivalent work experience
• 5+ years recent experience in Revenue Integrity; 2+ years in a leadership role with direct report performance management; 5+ years of health care coding and billing experience.

Nice to Have

• Additional related education and/or experience

Benefits

Certifications