Revenue Cycle Managed Services - Revenue Integrity Lead

Impact Advisors

About The Position

The Revenue Integrity Lead is responsible for leading client engagements focused on revenue optimization, charge capture improvement, compliance, reimbursement accuracy, and revenue cycle transformation. This individual serves as a subject matter expert in healthcare revenue integrity and partners with healthcare providers, executives, and operational leaders to identify opportunities that improve financial performance while maintaining regulatory compliance. The position will oversee assessments, process improvement initiatives, technology optimization efforts, revenue recovery projects, and revenue cycle transformation engagements. This role combines deep revenue cycle expertise, consulting experience, analytical capabilities, and leadership skills to deliver measurable outcomes for clients.

Requirements

Industry relevant certifications to include CHRI Certification in Healthcare Revenue Integrity (CHRI), Certified Revenue Integrity Professional (CRIP) or equivalent.
8+ years of healthcare revenue cycle experience.
5+ years of direct experience in revenue integrity, revenue cycle consulting, revenue optimization, or related healthcare financial operations.
Demonstrated experience leading complex healthcare improvement initiatives.
Strong knowledge of: Revenue Integrity programs, Charge Capture, Chargemaster (CDM) Management, Denials Management, Medicare and Medicaid reimbursement, Commercial payer reimbursement, Revenue Cycle Operations, Revenue Recovery, Revenue Compliance, Clinical Documentation Improvement concepts.
Advanced analytical and problem-solving skills.
Excellent executive communication and presentation abilities.

Nice To Haves

Bachelor’s or Master's degree in Healthcare Administration (MHA), Business Administration (MBA), Finance, or related field.
Experience within a healthcare consulting firm.
HFMA certifications.
Epic, Cerner, Oracle Health, Meditech, or other healthcare technology experience.
Experience supporting large integrated delivery networks and academic medical centers.

Responsibilities

Lead and manage revenue integrity consulting engagements for hospitals, health systems, physician groups, and other healthcare organizations.
Conduct comprehensive assessments of revenue cycle processes, charge capture workflows, billing practices, and reimbursement performance.
Identify opportunities to improve net revenue, reduce denials, enhance charge capture, and mitigate compliance risks.
Develop strategic recommendations and implementation roadmaps to address operational and financial improvement opportunities.
Serve as a trusted advisor to executive stakeholders and client leadership teams.
Evaluate revenue leakage risks across clinical, operational, and financial workflows.
Analyze charge master integrity, pricing methodologies, reimbursement trends, and payer contract performance.
Lead initiatives focused on: Charge capture optimization, Clinical documentation improvement collaboration, Revenue recovery, Denial prevention and reduction, Billing accuracy, Reimbursement enhancement, Cash acceleration.
Develop KPI dashboards and performance monitoring strategies.
Assess compliance with Medicare, Medicaid, commercial payer, and regulatory requirements.
Evaluate charging and billing practices to ensure alignment with applicable regulations and industry standards.
Identify audit risks and recommend corrective actions.
Support internal and external audit preparation and remediation activities.
Promote best practices related to revenue integrity governance and compliance.
Facilitate executive presentations and communicate findings to client stakeholders.
Lead workshops, operational assessments, and strategic planning sessions.
Build and maintain strong client relationships.
Develop project plans, manage timelines, and ensure successful engagement delivery.
Collaborate with multidisciplinary teams including clinical, finance, revenue cycle, compliance, and IT leaders.
Leverage revenue cycle data and analytics to identify performance gaps and financial improvement opportunities.
Interpret claims, billing, reimbursement, denial, and utilization data.
Recommend process and system enhancements within revenue cycle technologies.
Support implementation and optimization of EHR, billing, and revenue cycle platforms.
Implement and monitor benchmarking and performance measurement methodologies.
Mentor consultants, analysts, and team members.
Provide guidance on best practices in revenue integrity and revenue cycle management.
Contribute to thought leadership, solution development, and consulting methodologies.
Support business development efforts, including proposal development and client presentations.