Manager Revenue Integrity

The Manager of Revenue Integrity provides leadership and oversight of revenue integrity operations to support accurate, compliant, and complete capture of healthcare services and reimbursement. This position is responsible for managing processes related to charge capture, charge description master (CDM) maintenance, billing and coding integrity, reimbursement optimization, revenue leakage prevention, and regulatory compliance.

The Manager partners closely with clinical, operational, finance, coding, billing, compliance, and information technology teams to identify revenue opportunities, resolve charge and billing issues, improve workflows, and ensure services are accurately represented throughout the revenue cycle. This role provides leadership to Revenue Integrity staff and serves as a subject matter expert and organizational resource for revenue integrity practices.

Bachelor's degree in Health Information Management, Healthcare Administration, Business Administration, Healthcare Management, or related field, or equivalent combination of education and experience.

Minimum of five (5) years of progressively responsible experience in healthcare revenue cycle, revenue integrity, hospital billing, billing compliance, coding compliance, reimbursement, auditing, charge capture, or related operations.

Minimum of three (5) years of progressive leadership, supervisory, project leadership, or program oversight experience.

Demonstrated knowledge of hospital and/or professional billing requirements, reimbursement methodologies, Medicare, Medicaid, commercial payer requirements, and healthcare revenue cycle operations.

Working knowledge of CPT, HCPCS, ICD-10-CM, revenue codes, billing edits, charge capture, and healthcare billing and coding compliance requirements.

Experience analyzing complex revenue cycle issues, conducting audits or reviews, identifying root causes, and implementing corrective actions and process improvements.

Demonstrated ability to collaborate across clinical, operational, financial, compliance, and technical teams

Master's degree in Healthcare Administration, Business Administration, Health Information Management, Finance, or related field.

Certified Revenue Integrity Professional (CRIP) or other recognized revenue integrity certification.

Certified Revenue Cycle Representative (CRCR) or Certified Healthcare Financial Professional (CHFP).

Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA), or comparable coding/auditing credential.

Certified in Healthcare Compliance (CHC).

Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT).

Other applicable healthcare revenue integrity, reimbursement, coding, billing compliance, or revenue cycle certification.

Experience leading or supporting a formal revenue integrity program within a hospital or integrated health system.

Experience with Charge Description Master (CDM) management, charge capture optimization, billing compliance auditing, and revenue leakage prevention.

Experience with denial prevention, reimbursement optimization, payer audits, regulatory compliance, and revenue cycle process improvement.

Experience in a hospital, multi-specialty physician practice, or integrated health system environment.

Experience with Epic revenue cycle applications, charging workflows, work queues, reporting tools, and revenue integrity functionality.

• Manages and oversees daily revenue integrity activities to ensure accurate charge capture, compliant billing practices, reimbursement integrity, and timely resolution of identified issues.
• Develops and maintains a comprehensive revenue integrity monitoring…