Lead and manage Revenue Integrity operations, ensuring accurate charge capture, coding, billing, and reimbursement processes.
Oversee the maintenance and governance of the Charge Description Master (CDM), including code updates, pricing changes, and regulatory compliance.
Ensure proper mapping of charge codes and billing workflows within the hospital information system.
Develop and implement charge audit, reconciliation, and monitoring processes to identify revenue leakage and improve revenue capture.
Conduct financial and operational reviews to assess charge capture accuracy and billing completeness.
Ensure compliance with payer requirements, healthcare regulations, and coding standards including CPT, HCPCS, and DRG methodologies.
Collaborate with clinical, finance, revenue cycle, billing, and insurance departments to improve revenue cycle performance.
Lead cross-functional initiatives focused on revenue enhancement, operational efficiency, and process improvement.
Oversee pricing structures and support the preparation of patient and payer cost estimates.
Qualifications
Bachelor's degree in Healthcare Administration, Health Information Management, Finance, Accounting, Business Administration, or a related field.
Master's degree preferred.
Professional certification such as CPC, CCS, RHIA, RHIT, CHFP , or equivalent preferred.
Strong knowledge of healthcare revenue cycle operations, coding compliance, and reimbursement methodologies.
Requirements
Minimum 5-7 years of progressive experience in Revenue Cycle, Revenue Integrity, Patient Financial Services, Healthcare Finance, or related healthcare operations.