Director - Revenue Integrity (Remote)

Stanford Health Care•Hubley Township, PA

1d•$84 - $111•Remote

About The Position

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. The Director partners closely with clinical departments, School of Medicine leaders and physicians, Advanced Practice Providers (APPs), Coding, Office of Compliance and Privacy, Patient Financial Services, Professional Billing, Finance, Managed Care Contracting, and Technology and Digital Solutions (TDS) to ensures that charging and billing processes are transparent, auditable, and aligned with organizational financial and regulatory objectives. This includes partnership with TDS and Epic application teams to optimize system design, automation, testing, and validation of charge capture and billing workflows to ensure accuracy, efficiency, and safeguarding of revenue.

Requirements

Bachelor’s degree from an accredited college or university with a major in business administration, health care administration, or a related field is required.
Seven (7) years of progressively responsible and directly related work experience.
Proven progressive leadership experience in revenue integrity, CDM management, charge capture, or healthcare finance.
Demonstrated leadership experience management teams, complex, cross-functional initiatives.
Strong Knowledge of healthcare reimbursement, revenue cycle workflows and regulatory requirements
Knowledge of all aspects of healthcare revenue cycle functions, including registration, coding and documentation standards, billing and collection processes, as well as government and payer regulations.
Knowledge of CMS regulations, medical terminology and the various data elements associated with the UB-04 and CMS-1500 claim form.
Knowledge of medical records, hospital bills, and service item master.
Knowledge of principles and practices of organization, administration, fiscal and personnel management.
Knowledge of local, state and federal regulatory requirement related to the functional area.
Ability to conduct and interpret qualitative and quantitative analysis, financial analysis, healthcare economics and business processes, information systems, organizational development, health care delivery systems, project management or new business development.
Ability to manage, organize, prioritize, multi-task and adapt to changing priorities.
Ability to provide leadership and influence others.
Ability to foster effective working relationships and build consensus.
Ability to mediate and resolve complex problems and issues.
Ability to develop long-range business plans and strategy.
Certified Healthcare Revenue Integrity - CHRI required Upon Hire or
CPC - Certified Professional Coder required Upon Hire or
CCS - Certified Coding Specialist required Upon Hire or
RHIT - Registered Health Information Technician required Upon Hire or
RHIA - Registered Health Information Administrator required Upon Hire

Nice To Haves

Member in the Healthcare Financial Management Association (HFMA), National Association Healthcare Revenue Integrity (NAHRI) or American Health Information Management Association (AHIMA) preferred.

Responsibilities

Lead enterprise Charge Description Master (CDM) Governance, maintenance, and continuous improvement, ensuring accuracy, clarity and regulatory compliance.
Establishes 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
Maintains 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. Directs and approves all changes made to the hospital’s charge description master and professional fee schedule, consistent with third party requirements.
Assists in the resolution of problems causing payer denial or failed Medicare edits as they involve the charge master and the professional billing office.
Works collaboratively with the revenue producing department staff, physicians and school of medicine (SOM) to ensure all charges are captured and documented.
Fosters 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.
Oversees efforts to ensure timely response and compliance with regulatory agencies.
Educates hospital departments and physicians with respect to the use and maintenance of the charge master and charging philosophy.
Ensures timely review of regulatory literature such as Medicare Newsletter, Program Transmittals and CPT and HCPCS guidelines and implements necessary changes affecting Stanford Hospital and Clinic’s CDM and charge capture systems.
Coordinates 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.
Ensures the on-going 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.
Identifies services that are reimbursable but are not being charged; reviews, assigns, and validates CPT, HCPCS and revenue codes and sets rate. Determines charge and charge attributes for new services and products and responsible for developing and maintaining a rate setting policy.
Assists in the resolution of problems causing payer denial or failed Medicare edits as they involve the charge master and professional fee schedule. Works collaboratively with the revenue producing department staff and physicians to ensure all charges are being captured and documented.
Facilitates 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.
Establishes 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. Participates in Manage Care Contracting Committee as a member, with active involvement in pricing and contracting strategy decisions. Ensures that payor contract performance is monitored.
Participate in various TDS-related steering committees for information technology changes which affect the revenue cycle and leads planning initiatives for revenue cycle TDS related enhancements.
Establishes performance goals and expectations relevant to both hospital and professional revenue cycle. Prepares annual objectives, plan of action and budgets, as appropriate. Monitors benchmark data related to revenue cycle performance.
Establishes interim fee adjustments, annual CDM and CPT code changes, and EHR preference list updates.
Develops and produces executive and board level Revenue Capture dashboard reporting, recommendations and oversight of organization-wide CDM and Revenue Cycle strategies and process improvements.
Plans and schedules annual audit of selected hospital departments; compares medical records against claim to ensure optimum and appropriate charge capture and coding accuracy.
Manages and monitors the performance of external vendors that provide CDM related products and services; selects and coordinates any third-party vendor conducting annual charge master reviews or periodic updates.
Designs, analyzes, and implements information and reporting systems to monitor, detect and correct variations in revenue cycle performance.
Oversees the Revenue Integrity Program Managers performing daily CDM operations and updates.
Collaborate with Strategic Pricing in Finance on pricing alignment (Finance retains ownership of pricing strategy).
Ensure timely adoption of CPT/HCPCS, revenue code, and CMS regulatory updates.
Oversee charge configuration, testing, and EHR integration of new items and services.
Support audit readiness and resolve CDM-related compliance issues.
Lead process improvement initiatives to improve charge accuracy, workflow efficiency, and revenue integrity.
Develop, track, and report KPIs related to CDM performance and charge accuracy.