Director - Revenue Integrity; Remote

This is a Stanford Health Care job.

The Director of Revenue Integrity delivers enterprise strategic and operational leadership to drive accurate, compliant, and optimized revenue capture across inpatient, outpatient, professional (faculty practice) and research‑related services. This role is accountable for preventing revenue leakage and compliance risk through standardized charge capture, pricing governance, CDM management, revenue reconciliation, and analytics. The Director serves as the liaison between Revenue Cycle, clinical departments, and the School of Medicine.

Stanford Health Care

• Lead enterprise Charge Description Master (CDM) Governance, maintenance, and continuous improvement, ensuring accuracy, clarity and regulatory compliance.
• Establish revenue cycle reporting requirements to meet the needs and expectations of all constituencies (Director, Finance & Administration – DFAs; Faculty, Director of School Medicine Finance Support) and ensures timely reporting of revenue cycle performance through collaboration with appropriate information sources.
• Maintain the Hospital’s charge description master (CDM) by incorporating new charges/services identified by the Revenue Integrity Program Managers, as well as the revenue generating departments, third party changes, CMS special requirement and coding updates. Direct and approve all changes made to the hospital’s charge description master and professional fee schedule, consistent with third party requirements.
• Assist in the resolution of problems causing payer denial or failed Medicare edits as they involve the charge master and the professional billing office.
• Work collaboratively with the revenue producing department staff, physicians and School of Medicine to ensure all charges are captured and documented.
• Foster partnering relationships with the Office of Compliance and Privacy, Patient Financial Services, Professional Billing Office, Coding, and other third parties to ensure the accuracy of the CDM, fee schedules and research CDM.
• Oversee efforts to ensure timely response and compliance with regulatory agencies.
• Educate hospital departments and physicians with respect to the use and maintenance of the charge master and charging philosophy.
• Ensure timely review of regulatory literature such as Medicare Newsletter, Program Transmittals and CPT and HCPCS guidelines and implement necessary changes affecting Stanford Hospital and Clinic’s CDM and charge capture systems.
• Coordinate with Patient Financial Services, Professional Billing Office, and Coding to ensure that the codes contained in the CDM and professional fee schedule are accurate and in compliance with regulatory and/or contractual guidelines and that claims logic is appropriate for accurate billing.
• Ensure the ongoing accuracy and integrity of the CDM and professional fee schedule by ensuring that all charges are communicated and coordinated with the performing departments and physicians to implement necessary changes to charge documents, charge capture process, and order entry procedures.
• Identify services that are reimbursable but are not being charged; review, assign, and validate CPT, HCPCS and revenue codes and set rate. Determine charge and charge attributes for new services and products and be responsible for developing and maintaining a rate setting policy.
• Assist in the resolution of problems causing payer denial or failed Medicare edits as they involve the charge master and professional fee schedule. Work collaboratively with the revenue producing department staff and physicians to ensure all charges are being captured and documented.
• Facilitate positive communication and build strong relationships between Professional Revenue Cycle Management Operations and clinical chairs (School of Medicine), administrators, other clinic and departmental staff and payors regarding revenue cycle matters.
• Establish revenue cycle reporting requirements, as above, and participate in Managed Care Contracting Committee as a member, actively involved in pricing and contracting strategy decisions. Ensure that payor contract performance is monitored.
• Participate in…