Job Description

Staff Position Description

Position Title: Director of Revenue Integrity

Department: Revenue Integrity

Reports to: Senior Director of Revenue Cycle

Position Purpose:

The Director of Revenue Integrity is responsible for ensuring the organization accurately captures, charges, bills, and receives reimbursement for all services provided in a manner that is compliant with federal, state, payer, and regulatory requirements. This role serves as the primary leader for revenue integrity activities across Kingman Regional Medical Center, overseeing processes that ensure patients are billed only for services rendered, charges are supported by clinical documentation, and reimbursement is accurate and compliant with CMS and other payer regulations.

The Director provides strategic leadership and operational oversight for the Charge Description Master (CDM), charge capture and reconciliation, revenue compliance audits, regulatory reviews, denial prevention and management, underpayment recovery, and revenue integrity education. This position partners closely with Clinical Operations, Finance, Health Information Management, Coding, Patient Financial Services, and Information Systems to maintain the integrity of clinical and financial data throughout the revenue cycle.

The Director acts as a key advisor to executive leadership on revenue optimization opportunities, reimbursement risks, regulatory changes, and compliance initiatives that impact the organization's financial performance. Through proactive monitoring, analysis, and collaboration, this role safeguards organizational revenue, supports regulatory compliance, and promotes accurate reimbursement for both hospital and professional services.

Key Responsibilities

• Provides leadership, direction, and oversight for the organization's Revenue Integrity program, ensuring accurate charge capture, compliant billing practices, and appropriate reimbursement for all hospital and professional services.
• Collaborates with clinical, operational, finance, patient financial services, health information management, coding, compliance, and information systems teams to ensure clinical services are accurately translated into compliant billable charges.
• Develops and implements revenue integrity auditing programs, including charge capture reviews, regulatory compliance audits, billing validation audits, and targeted departmental assessments.
• Analyzes revenue cycle performance, denial trends, audit findings, reimbursement variances, and payer payment activity to identify opportunities for revenue enhancement and operational improvement.
• Leads investigations and resolution of revenue-related system issues, charge discrepancies, and data integrity concerns impacting reimbursement, regulatory compliance, or financial reporting.
• Develops, monitors, and reports key revenue integrity metrics, providing actionable recommendations to leadership that improve revenue capture, reduce denials, and strengthen compliance.
• Provides education and training to clinical, operational, and revenue cycle staff regarding charge capture requirements, documentation standards, regulatory updates, billing compliance, and revenue integrity best practices.
• Establishes and maintains revenue integrity policies, procedures, and internal controls that support regulatory compliance, audit readiness, and financial stewardship.
• Oversees vendor relationships and performance associated with revenue integrity functions, including payer credentialing, reimbursement recovery, auditing, charge capture technology, and revenue cycle consulting services.
• Partners with organizational leadership to evaluate new services, technologies, procedures, and payer requirements to ensure proper charge structure, reimbursement methodology, and revenue cycle compliance prior to implementation with a commitment to continuous improvement by identifying opportunities to strengthen revenue processes, enhance reimbursement accuracy, improve compliance outcomes, and optimize the organization's financial performance.
• Performs other duties as assigned to support overall effectiveness of department and organization.

Qualifications

Education

Bachelor's degree in Healthcare Administration, Finance, Accounting, Business Administration, Health Information Management, or a related field required.

Experience

• Minimum of seven (7) years of progressively responsible healthcare revenue cycle experience, including charge capture, revenue integrity, reimbursement, billing compliance, denial management, coding, or patient financial services.
• Minimum of three (3) years of leadership experience managing revenue cycle, revenue integrity, reimbursement, or related healthcare financial operations.
• Demonstrated experience with Charge Description Master (CDM) management, charge capture processes, revenue integrity auditing, and revenue cycle compliance.
• Experience analyzing and interpreting CMS regulations, Medicare and Medicaid reimbursement methodologies, payer requirements, and revenue cycle operational impacts.
• Experience collaborating with clinical, operational, finance, information systems, and revenue cycle departments to implement revenue integrity initiatives and resolve complex reimbursement issues.
• Experience overseeing vendors, consultants, or contracted services related to revenue integrity, payer enrollment, reimbursement recovery, auditing, or revenue cycle operations preferred.
  Skills and Knowledge
• Comprehensive knowledge of healthcare revenue cycle operations, including patient access, charge capture, coding, clinical documentation, billing, reimbursement, accounts receivable, denials management, and regulatory compliance.
• Strong understanding of CMS, Medicare, Medicaid, commercial payer requirements, hospital reimbursement methodologies, and applicable healthcare regulations.
• Knowledge of Charge Description Master governance, revenue integrity best practices, revenue compliance auditing, and reimbursement optimization strategies.
• Demonstrated ability to analyze complex financial, operational, and clinical data and develop actionable recommendations.
• Strong leadership, communication, project management, and relationship-building skills with the ability to influence organizational change across multiple departments.
• Proficiency with electronic health record systems, revenue cycle applications, decision support tools, and data analytics platforms.
• Ability to exercise independent judgment and make strategic decisions involving revenue risk, compliance exposure, reimbursement opportunities, and operational improvement initiatives.
• Strong presentation, training, and educational skills with the ability to communicate complex regulatory and reimbursement concepts to diverse audiences.
• Advanced analytical, mathematical, and problem-solving skills with a focus on revenue optimization, regulatory compliance, and financial stewardship
• Exercises independent judgment and decision-making authority in evaluating revenue risks, interpreting regulatory guidance, resolving complex reimbursement issues, and implementing corrective action plans.

Preferences

Master's degree in a healthcare, business, finance, or related discipline preferred.

Special Position Requirements

Blood Borne Disease Exposure Category: Category III

Work Requirements

Ability to sit for six (6) to seven (7) hours daily at a computer terminal; ability to use computer keyboard; occasionally lifts and carries 11 to 25 pounds of files; telephone and face to face contact with the public and employees is frequent and must be able to deal professionally at all levels of interaction.

Date Staff Position Description Created / Revised: 02/07/2019; 7/27/2026

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