Director - Revenue Integrity - FT - Days - MHS

Memorial Healthcare

2d•Onsite

About The Position

The Director of Revenue Integrity is responsible for leading all revenue‑integrity functions across the healthcare system, ensuring accurate, compliant, and optimized revenue capture. This role oversees charge capture, charge reconciliation, CDM (Charge Description Master) maintenance, pricing strategy, payment validation, and denial prevention. The Director acts as the primary liaison between clinical departments, revenue cycle operations, and Epic application teams, ensuring that workflows, charge logic, and billing processes are accurate, efficient, and aligned with regulatory requirements.

Requirements

Bachelor's degree in Finance, Accounting, Business Administration, or in a job related field.
A minimum of seven (7) years of relevant experience including five (5) years of experience supervising/managing a team.
Thorough knowledge of Medicare and Medicaid, rules and regulations, correct coding, and billing instructions.
Experience in Epic Resolute Hospital Billing (HB) and a deep understanding of Charge Router logic, Charge Review Workqueues, Charge triggers and automated charge capture.
Proficient in Microsoft Office products.

Nice To Haves

Business Acumen
Concern for Quality
Develop Relationships
Lead Through Vision
Manage Performance

Responsibilities

Directs the development, maintenance, and governance of the organization’s pricing strategy within Epic and related systems.
Coordinates charge capture matters with other affected Epic teams (Radiant, Beaker, OpTime, etc.) and key departments (e.g., Supply Chain) to ensure accurate integration of data and workflows.
Prepares, monitors, and evaluates departmental budget and ensures that the department operates in compliance with allocated Memorial funding.
Monitors, evaluates, and responds to changes in the state and federal legislative and regulatory rules affecting governmental payors, and communicates issues, concerns, and opportunities to affected parties in Memorial Healthcare System (MHS).
Identifies barriers for self and team to timely complete priority projects and collaborates with others to overcome those barriers.
Oversees staff relations including performance management, staff satisfaction, conflict management and requirements.
Develops and implements departmental goals and priorities, plans, standards, policies, and procedures for building and maintaining the system charge master that is consistent with the clinical, administrative, legal, and ethical requirements and objectives of the organization.
Responsible for designing and implementing processes for accurate and timely charge capture, audit controls, and approvals.
Plans and monitors staffing activities including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.
Makes high‑level decisions regarding departmental operations including applications procurement and purchasing, service level determination, and complaint management, to achieve performance and quality control objectives.
Serves as a strategic partner with Information Technology and other departments to ensure appropriate charge capture processes are integrated with the implementation of new systems or organizational changes.
Oversees creation and maintenance of machine‑readable files, shoppable services lists, and patient‑facing cost‑estimate tools.
Allocates resources to other departments in order to monitor and provide training, support and troubleshooting to end-users of business applications.
Stays abreast of market and industry research to inform application decisions and provide thought leadership around application enhancements and management.
Acts as primary contact point and liaison to Memorial's Charge Description Master (CDM) and technology function by overseeing the planning, design, and installation of all relevant application systems.