Director, Revenue Integrity

South Shore Health•Weymouth, MA

46d•$145,000 - $210,300

About The Position

The Director of Revenue Integrity provides strategic and operational leadership for hospital charge capture, charge integrity, reimbursement analytics, denial and payment variance management. This role oversees enterprise charge reconciliation processes, charge audits, CDM (Charge Description Master) governance, charge edit optimization, payer variance resolution, and business intelligence initiatives in support of the health system's revenue cycle. The Director serves as a subject matter expert in Epic-based charge capture, reimbursement methodologies, and payer policies, ensuring optimal revenue performance, compliance with regulatory requirements, and alignment with organizational financial goals.

Requirements

Bachelor's degree preferred in related field, high school diploma required
7-10 years of progressive revenue cycle, reimbursement or revenue integrity leadership experience in a hospital or health system environment
In-depth knowledge of Epic EMR charge capture, CDM, charge router, and reporting tools required.
Strong understanding of reimbursement methodologies, payer contracting, and revenue cycle operations.
Demonstrated success in leading cross-functional teams, implementing charge integrity programs, and leveraging analytics to drive performance.
Strong leadership skills to motivate cross-functional teams' performance toward excellence using team concepts and consensus-building management styles.
Effective organizational skills and ability to manage multiple initiatives simultaneously.
Advanced/effective interpersonal, written/verbal communication and presentation skills, along with the ability to communicate complex Revenue Cycle and performance improvement concepts to others without a Revenue Cycle background.
Possesses a growth mindset, critical thinking skills, and is root cause and corrective-action focused.
Ability to prioritize multiple objectives in a rapidly changing environment and deliver quality outcomes.
Ability to develop and maintain effective relationships at all levels throughout the organization.
Advanced analytic and metric management skills, including the ability to analyze data and KPIs for performance, operations, budgeting, staffing, and financial reporting.
Ability to translate key performance indicator levels into a finance-based business case, then design, implement, and manage more effective and efficient processes.

Responsibilities

Provide leadership for enterprise charge capture, reconciliation, and integrity processes across hospital and professional departments, ensuring accurate and compliant billing.
Oversee ongoing review and maintenance of the Charge Description Master (CDM), partnering with clinical, compliance, and financial leaders to align coding, pricing, and charging practices with regulatory standards.
Lead charge audit initiatives to identify gaps, missed charges, duplicate charges, and opportunities for improved revenue integrity.
Manage and optimize Epic charge capture workflows, charge router edits, and charge review edits to support efficiency, accuracy, and compliance.
Direct analysis and resolution of payer reimbursement variances, collaborating with Patient Financial Services, Managed Care, and contracting teams.
Partner with Patient Financial Services, Finance, and Clinical Operations teams to evaluate the financial impact of reimbursement changes, payer policy updates, and charge capture initiatives.
Lead the design, development, and delivery of revenue cycle business intelligence reports, dashboards, and analytics tools to support informed decision-making.
Collaborate with hospital and physician leadership to implement charge capture best practices, education, and policy standardization across the enterprise.
Ensure timely monitoring, reporting, and resolution of charge and reimbursement issues identified through audits, variance reporting, or regulatory changes.
Develop and mentor a team responsible for charge integrity, CDM, charge edits, and reimbursement analytics.
Stay abreast of industry trends, CMS regulations, and payer policy changes, ensuring organizational readiness and proactive response to reimbursement challenges.
Prepare for and respond to audits, mitigating risk, and ensuring defensible billing practices.
Manage vendor relationships, negotiate contracts, and oversee service-level agreements
Collaborate with IT, clinical operations, and external partners to ensure seamless integration and workflow efficiency
Validate and respond to state reporting through CHIA
Establish revenue cycle informatics team for education on charge capture and reconciliation
Monthly reports on denials for hospital and professional billing, analyzing trends and communicating back to charging departments
Report on denial trends for all types including but not limited to level of care, medical necessity, authorization, etc.