System Director Revenue Integrity

Quorum Health•Brentwood, TN

7h•Remote

About The Position

The System Director, Revenue Integrity leads the health system’s enterprise Revenue Integrity function and sets the strategy, governance, controls, and operational infrastructure needed to ensure complete, accurate, compliant, and timely revenue capture across the organization. The Director serves as the system’s leader for charge capture, chargemaster (CDM) governance, clinical revenue cycle integration, revenue leakage prevention, reimbursement compliance, and Revenue Integrity performance. The role partners closely with Finance, Revenue Cycle, Clinical Operations, Coding/HIM, Compliance, Information Technology, Supply Chain, Pharmacy, and hospital leadership to ensure clinical activity is translated into compliant and collectible revenue. It provides enterprise oversight across hospitals, ambulatory locations, professional services, ancillary departments, and other applicable business units, and leads continued development of the Revenue Integrity operating model, including organizational structure, policies, governance, technology, analytics, education, auditing, and performance management.

Responsibilities

Develop and execute the health system’s enterprise Revenue Integrity strategy, operating model, and multi-year roadmap.
Establish standardized Revenue Integrity policies, procedures, controls, and governance across hospitals and business units.
Define accountability for charge capture, charge reconciliation, chargemaster maintenance, documentation, coding, and related operational processes.
Serve as the executive subject matter expert for Revenue Integrity and advise senior leadership on compliance risk, revenue opportunity, operational performance, and strategic priorities.
Lead the development and continued maturation of the enterprise Revenue Integrity organizational structure and build strong working relationships with hospital presidents, CFOs, COOs, clinical executives, Revenue Cycle leadership, Compliance, IT, HIM, Coding, Pharmacy, Supply Chain, and departmental leaders.
Provide enterprise oversight of charge capture across hospital, professional, ambulatory, procedural, diagnostic, pharmacy, supply, implant, and ancillary services.
Develop standardized charge reconciliation processes and controls to identify missing, duplicate, delayed, inaccurate, or unsupported charges.
Partner with clinical departments to integrate charging into workflows; monitor late charges, manual charges, charge corrections, charge lag, and other indicators of revenue leakage or process failure; and establish departmental accountability for charge capture performance.
Provide executive oversight of hospital chargemasters, professional fee schedules, charging dictionaries, and related reference files.
Establish enterprise CDM standards for CPT and HCPCS assignment, revenue codes, modifiers, pricing, charge descriptions, charge logic, and billing configuration.
Develop CDM maintenance processes covering code updates, regulatory changes, new services and technology, and charge requests; establish governance for changes to chargeable services and promote consistent charging methodologies where appropriate.
Partner with Finance and executive leadership on pricing strategy, gross charge methodologies, and compliance with hospital price transparency requirements.
Develop a comprehensive enterprise Revenue Integrity audit and monitoring program, including risk-based audit priorities based on financial, operational, regulatory, and utilization data.
Identify and address missing or incorrect charges, coding discrepancies, documentation deficiencies, billing errors, payer issues, and reimbursement variances.
Ensure findings lead to documented corrective action and follow-up monitoring, supported by education, workflow remediation, or system changes as needed; validate that corrective actions remain effective.
Quantify and report financial opportunities, recoveries, prevented revenue leakage, and compliance-related findings.
Monitor CMS, state, and other regulatory requirements, AMA coding guidance, and commercial payer policies affecting charging, coding, reimbursement, and billing; translate changes into operational, system, and CDM updates.
Partner with Compliance, Coding, HIM, and Legal as appropriate to interpret and operationalize billing and reimbursement requirements; coordinate Revenue Integrity with Coding, Clinical Documentation Integrity, Billing, Denials, Contracting, and Compliance.
Partner with clinical and operational leaders to improve charge-capture accuracy and reliability at the point of care.
Develop service-line-specific strategies for high-risk or high-value areas, including Surgery, Cardiology, Cath Lab, Interventional Radiology, Emergency Services, Pharmacy, Infusion, Imaging, Laboratory, Rehabilitation, Oncology, and supply and implant charging.
Integrate Revenue Integrity review into new service development, technology implementation, workflow redesign, and capital planning; educate leaders on their role in revenue capture and billing compliance.
Promote a culture in which Revenue Integrity is a shared operational responsibility rather than solely a back-end Revenue Cycle function.
Partner with IT and application teams to ensure EHR and revenue cycle systems support accurate, efficient, and compliant charge capture.
Provide Revenue Integrity leadership for EHR implementations, conversions, upgrades, and optimization initiatives; oversee requirements for charging workflows, charge routers, automated charging, interfaces, preference lists, order-to-charge logic, supply and pharmacy charging, professional charge capture, and related functionality.
Ensure charging logic and CDM configuration are tested before implementation; establish governance for system configuration changes affecting charging, billing, or reimbursement; promote automation and exception-based workflows where appropriate.
Develop an enterprise Revenue Integrity performance framework and executive dashboard, including KPIs for charge capture, charge lag, late charges, reconciliation completion, CDM accuracy, audit findings, financial opportunity, corrective action, and departmental performance.
Use analytics to identify trends, outliers, risks, and opportunities; provide transparent reporting to senior leadership and operational stakeholders; develop departmental scorecards and accountability mechanisms where appropriate.
Track financial value generated through Revenue Integrity initiatives, including recovered revenue, prevented leakage, process improvement, and risk mitigation.
Recruit, develop, and retain a high-performing Revenue Integrity leadership and technical team; establish clear roles, career pathways, succession planning, and competency standards.
Develop an enterprise education program for Revenue Integrity employees, clinical departments, operational leaders, and other stakeholders; promote ongoing professional development and relevant certifications.