Director Revenue Integrity

Texas Health Resources•Arlington, TX

1d•Remote

About The Position

The Director of Revenue Integrity provides strategic, operational, and organizational leadership for enterprise-wide charge capture governance, charge reconciliation, audit escalation strategy, charge compliance, clinical documentation improvement initiatives related to charging accuracy, revenue leakage prevention, denials prevention, regulatory compliance, and revenue integrity optimization. The Director leads managers and teams responsible for charge capture operations, charge audits, revenue integrity analytics, charge reconciliation, charge compliance, education, and performance improvement activities. The role establishes enterprise standards, develops long-term strategies, oversees organizational performance, and partners with executive leadership, clinical departments, finance, compliance, IT, coding, billing, and revenue cycle leaders to ensure accurate, compliant, and efficient revenue recognition across the organization. The role is accountable for establishing a culture of operational excellence, standardization, accountability, and continuous improvement while ensuring alignment with organizational financial, compliance, and strategic priorities.

Requirements

Bachelor's Degree and 10 years experience required.
Master's Degree and 8 years experience is preferred
8 years progressive leadership experience in healthcare revenue cycle, revenue integrity, charge capture, charge reconciliation, charge compliance, auditing, coding, finance, clinical operations, or related healthcare operations.
Experience must include Epic EMR and leadership of complex operational functions, large-scale projects, operational transformation initiatives, process improvement efforts, and technology implementations, with demonstrated success driving organizational performance, financial outcomes, regulatory compliance, and cross-functional collaboration. (with a Masters) required.
10 years progressive leadership experience in healthcare revenue cycle, revenue integrity, charge capture, charge reconciliation, charge compliance, auditing, coding, finance, clinical operations, or related healthcare operations.
Experience must include Epic EMR and leadership of complex operational functions, large-scale projects, operational transformation initiatives, process improvement efforts, and technology implementations, with demonstrated success driving organizational performance, financial outcomes, regulatory compliance, and cross-functional collaboration. (with a Bachelors) required.
CRCR - Certified Revenue Cycle Representative Obtain and maintain through THR HFMA Enterprise membership required within 12 months of hire
Expert knowledge of healthcare revenue cycle operations, charge capture, charge audit, charge compliance, reimbursement methodologies, and payer requirements.
Advanced understanding of CMS regulations, regulatory compliance, healthcare finance, denials prevention, and revenue optimization strategies.
Demonstrated ability to lead large, complex, enterprise-wide initiatives and organizational change efforts.
Strong financial acumen with ability to quantify impact, evaluate risk, and develop business cases.
Advanced leadership, communication, executive presentation, negotiation, and stakeholder management skills.
Ability to influence decision-making across executive, physician, operational, financial, and clinical leadership groups.
Strong analytical, strategic planning, organizational development, and performance management capabilities.
MS Office including Word, PowerPoint, Excel, and Outlook

Nice To Haves

CPC - Certified Professional Coder or RHIA - Registered Health Information Administrator preferred upon hire

Responsibilities

Serve as Revenue Integrity subject matter expert and strategic advisor for the organization
Lead stakeholder engagement, change management, communication, and governance activities related to revenue integrity initiatives
Establish and execute the organization's Revenue Integrity strategy, governance framework, and operating model
Establish enterprise standards for charge capture workflows, charge audit methodology, charge reconciliation, documentation requirements, and education practices
Ensure alignment of Revenue Integrity objectives with organizational financial, operational, regulatory, and strategic priorities
Monitor departmental performance through dashboards, scorecards, service level agreements, and key performance indicators
Ensure timely resolution of enterprise charge capture issues, billing barriers, reconciliation variances, and audit findings
Oversee performance management, workforce planning, succession planning, and leadership development activities
Lead prioritization of enterprise projects, operational initiatives, and resource deployment
Foster a high-performing culture focused on accountability, collaboration, innovation, and customer service
Lead and oversee analysis of charge capture trends, recurring errors, compliance risks, revenue leakage opportunities, documentation gaps, and operational issues impacting revenue integrity performance
Direct retrospective, concurrent, targeted, complex, high-risk, and payer-sensitive audits to evaluate charge accuracy, documentation support, and compliance with charging rules, payer requirements, and regulatory standards
Ensure audit findings are documented, tracked, reported, and translated into remediation plans, education, workflow changes, or escalation pathways as appropriate
Oversee root cause analysis for moderately complex, recurring, systemic, cross-functional, or high-risk charge capture and documentation issues
Ensure compliance with CMS regulations, payer requirements, organizational policies, and industry standards
Direct identification, escalation, remediation, and monitoring of compliance risks, audit findings, revenue leakage opportunities, and billing vulnerabilities
Drive organizational efforts to improve revenue capture, reduce revenue leakage, and strengthen financial performance
Establish enterprise performance monitoring related to charge accuracy, reconciliation outcomes, denials prevention, audit findings, financial recovery, and billing readiness
Evaluate financial impact of operational issues and prioritize initiatives based on organizational risk and return
Develop executive-level reporting and business cases to support investment decisions and operational improvements
Lead initiatives that improve net revenue realization through enhanced charge capture accuracy, documentation support, and process standardization
Lead enterprise process improvement initiatives to improve efficiency, consistency, compliance, and scalability
Partner with cross-functional teams to optimize system configuration, automation opportunities, work queues, edits, and reporting capabilities
Lead large-scale operational transformation initiatives impacting revenue integrity and revenue cycle performance
Ensure consistent implementation of best practices across hospitals, outpatient departments, physician practices, and ambulatory clinics, and service lines
Promote data-driven decision making and continuous process improvement throughout the organization