Director, Revenue Integrity

City of Hope•United States, California, CA

1d•$136,697 - $228,300

About The Position

City of Hope is seeking an accomplished Director, Revenue Integrity to provide strategic and operational leadership for Revenue Integrity across its health system. The role oversees charge assurance, charge capture optimization, Charge Description Master governance, pre-claim revenue reconciliation, and revenue leakage prevention. The Director partners with clinical, operational, finance, coding, compliance, patient accounting, and information technology leaders to strengthen reimbursement outcomes, improve performance, and reduce financial risk throughout the revenue cycle. The Director leads system-wide initiatives to improve charge accuracy, billing readiness, and revenue realization; ensures timely implementation of charging, coding, reimbursement, and regulatory changes; and develops controls and monitoring tools for revenue integrity processes. This leader oversees CDM governance, optimization, regulatory updates, pricing support, and compliance reviews; works with clinical departments to establish charging and billing processes for new services and technologies; monitors performance and corrective action plans; develops Revenue Integrity staff; and serves as a subject matter expert for enterprise revenue cycle optimization and compliance.

Requirements

Bachelor’s degree, or three additional years of relevant experience in addition to the minimum experience requirement in lieu of the degree.
Seven or more years of hospital Revenue Integrity or Health Information Management experience.
Five years of management experience.
Strong clinical and/or clinical coding knowledge; billing compliance experience is desired.
Technical knowledge of CPT and HCPCS coding principles, modifier selection, and UB-04 revenue codes.
Experience conducting medical-record-to-bill reviews to validate charge capture accuracy.
Ability to execute strategy and communicate business processes and enabling technologies.
Experience with Epic and Craneware.

Nice To Haves

Bachelor’s degree in Business Administration, Healthcare Administration, Finance, Health Information Management, Nursing, or a related field.
RN, CRCR, CCS, CCA, CPC, RHIT, or RHIA certification.
Oncology revenue cycle experience.

Responsibilities

Direct Revenue Integrity operations, including charge capture, reconciliation, audits, CDM maintenance, and revenue leakage prevention.
Lead system-wide initiatives that improve charge accuracy, billing readiness, and revenue realization.
Ensure timely implementation of charging, coding, reimbursement, and regulatory changes.
Develop controls and monitoring tools for charge capture, late charges, and other revenue integrity processes.
Oversee CDM governance, optimization, annual regulatory updates, pricing support, and compliance reviews.
Partner with clinical departments to establish accurate charging and billing processes for new services, technologies, pharmaceuticals, and procedures.
Monitor performance against key metrics and service expectations, identify trends, and implement corrective action plans.
Lead, mentor, and develop Revenue Integrity managers, supervisors, and team members while supporting engagement, succession planning, and retention.
Collaborate with executive and cross-functional leaders on revenue optimization opportunities, operational risks, compliance concerns, and technology solutions.
Serve as a subject matter expert and organizational leader for enterprise revenue cycle optimization and compliance initiatives.