Revenue Cycle Managed Services – Revenue Integrity Lead
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JobgetherHealthcare revenue cycle
Based in the United StatesFull-TimeLead
SalaryEligibility for an annual performance bonus may be available for salaried positions, subject to applicable employment terms.
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Job Details
- Experience
- At least 8 years of experience in healthcare revenue cycle management, including a minimum of 5 years of direct experience in revenue integrity, revenue cycle consulting, revenue optimization, or related healthcare financial operations.
- Required Skills
- Project Management
Requirements
- Hold an industry-relevant healthcare revenue integrity certification, such as CHRI, CRIP, or an equivalent credential.
- Have at least 8 years of experience in healthcare revenue cycle management.
- Have at least 5 years of direct experience in revenue integrity, revenue cycle consulting, revenue optimization, or related healthcare financial operations.
- Demonstrate experience leading complex healthcare improvement initiatives and delivering measurable financial or operational results.
- Have expertise in revenue integrity programs, charge capture, chargemaster management, denial management, revenue recovery, revenue cycle operations, and revenue compliance.
- Have comprehensive knowledge of Medicare and Medicaid reimbursement, commercial payer reimbursement practices, and relevant regulatory requirements.
- Be familiar with clinical documentation improvement concepts and their relationship to reimbursement and revenue integrity.
- Demonstrate advanced analytical and problem-solving skills, including interpreting complex financial and operational data.
- Have executive communication and presentation skills, including the ability to explain findings and influence stakeholders.
- Have project management, leadership, and collaboration skills, including experience coordinating clinical, finance, revenue cycle, compliance, and IT stakeholders.
- Preferred: bachelor's or master's degree in Healthcare Administration, Business Administration, Finance, or a related discipline.
- Preferred: experience with Epic, Cerner, Oracle Health, or MEDITECH.
Responsibilities
- Lead consulting engagements focused on revenue integrity, revenue optimization, charge capture, reimbursement accuracy, and revenue cycle transformation.
- Evaluate revenue cycle operations, billing practices, charge capture workflows, and reimbursement processes to identify gaps, risks, and improvement opportunities.
- Identify revenue leakage and lead initiatives to improve charge capture, clinical documentation collaboration, billing accuracy, cash flow, and appropriate reimbursement.
- Analyze chargemaster data, pricing methodologies, payer contract performance, reimbursement trends, claims, denials, and utilization data.
- Develop KPI dashboards, benchmarking frameworks, and monitoring strategies to track performance.
- Evaluate charging and billing practices against Medicare, Medicaid, commercial payer requirements, and applicable regulations; support audits and remediation.
- Advise healthcare executives and operational leaders, facilitate workshops, present findings, and develop implementation roadmaps.
- Develop project plans, coordinate multidisciplinary teams, manage timelines, and deliver revenue improvement and transformation initiatives.
- Recommend enhancements to EHRs, billing systems, and revenue cycle platforms.
- Mentor team members and contribute to consulting methodologies, solution development, proposals, and client presentations.
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