System Director Revenue Integrity

Quorum Health Corporate•Brentwood, TN

14h•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 role 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 Director partners with Finance, Revenue Cycle, Clinical Operations, Coding/HIM, Compliance, Information Technology, Supply Chain, Pharmacy, and hospital leadership to ensure clinical activity is accurately translated into compliant and collectible revenue. The position provides enterprise oversight across hospitals, ambulatory locations, professional services, ancillary departments, and other applicable business units. The Director leads the continued development and maturation of the Revenue Integrity operating model, including organizational structure, policies, governance, technology, analytics, education, auditing, and performance management. The position is remote, with residence required in one of the listed eligible states.

Responsibilities

Develop and execute the 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 revenue-related operational processes.
Advise senior leadership on compliance risk, revenue opportunities, operational performance, and strategic priorities as the executive subject matter expert for Revenue Integrity.
Lead development and maturation of the enterprise Revenue Integrity organizational structure and build relationships with hospital and functional leaders.
Oversee 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 processes into clinical and operational workflows; monitor late charges, manual charges, charge corrections, charge lag, and other revenue leakage indicators.
Establish departmental ownership and 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 for code updates, regulatory changes, new services, new technology, and charge requests; establish governance for changes to chargeable services.
Promote consistent charging methodologies where clinically and operationally appropriate and partner with Finance and executive leadership on pricing strategy, gross charge methodologies, and hospital price transparency compliance.
Develop an enterprise Revenue Integrity audit and monitoring program; identify and address missing or incorrect charges, coding discrepancies, documentation deficiencies, billing errors, payer issues, and reimbursement variances.
Set risk-based audit priorities using financial, operational, regulatory, and utilization data; ensure findings lead to corrective action and follow-up monitoring.
Quantify and report financial opportunities, recoveries, prevented revenue leakage, and compliance-related findings, and validate corrective actions over time.
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 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 at the point of care and develop service-line-specific strategies for high-risk or high-value areas.
Incorporate Revenue Integrity review into new service development, new technology implementation, workflow redesign, and capital planning; educate leaders on revenue capture and billing compliance responsibilities.
Partner with IT and application teams to ensure EHR and revenue cycle systems support accurate, efficient, and compliant charge capture.
Lead Revenue Integrity efforts for EHR implementations, conversions, upgrades, and optimization; 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 and establish governance for system configuration changes affecting charging, billing, or reimbursement.
Promote appropriate automation and exception-based workflows to reduce manual intervention and improve accuracy.
Develop an enterprise Revenue Integrity performance framework, executive dashboard, KPIs, transparent reporting, departmental scorecards, and accountability mechanisms.
Use analytics to identify trends, outliers, risks, and opportunities across hospitals and service lines and track the financial value of Revenue Integrity initiatives.
Recruit, develop, and retain a high-performing Revenue Integrity leadership and technical team; establish clear roles, competency standards, career pathways, and succession planning.
Develop enterprise education for Revenue Integrity employees, clinical departments, operational leaders, and other stakeholders, and promote professional development and relevant certifications.