Program Integrity Director Jobs in Encinitas, CA

This Senior Director position is eligible to participate in the Director Incentive Plan.

Located in La Jolla and requires residence in San Diego County. 

Why join Scripps Health?

AWARD-WINNING WORKPLACE: 

At Scripps Health, your ambition is empowered, and your abilities are appreciated: 

• Nearly a quarter of our employees have been with Scripps Health for over 10 years.
• Scripps is a Great Place to Work Certified company for 2025.
• Scripps has been consistently ranked as a top employer for women, millennials, diversity, and as an overall workplace by various national publications.
• Beckers Healthcare ranked Scripps Health on its 2026 list of 150 top places to work in health care.
• We have transitional and professional development programs to create a learning environment that enables you to thrive in your specific field as well as in your overall career.

• Our specialties have been nationally recognized for quality in areas such as cardiovascular care, oncology, orthopedics, geriatrics, obstetrics and gynecology, and gastroenterology.

The Senior Director, Revenue Cycle - Clinical Documentation Integrity provides strategic leadership and operational oversight for systemwide Coding, Clinical Documentation Integrity (CDI), and Health Information Management (HIM), encompassing both hospital and professional fee services. This role is responsible for advancing documentation quality, coding accuracy, and compliance to ensure the integrity of clinical and financial data across the Scripps Health system. Through cross-functional collaboration, data-driven decision-making, and innovative process improvement, the Senior Director drives excellence in revenue cycle performance, supports clinical and operational goals, and promotes exceptional patient and provider experience.

As we continue to build on this success, we are seeking an accomplished leader to join us as Senior Director, Revenue Cycle - Clinical Documentation Integrity (CDI). This critical leadership role will advance documentation accuracy, coding excellence, and information integrity across the Scripps system, spanning both hospital and professional fee settings.

The Senior Director will have enterprise accountability for the oversight and performance of Clinical Documentation Integrity (CDI), Coding, and Health Information Management (HIM), ensuring alignment of clinical, operational, and financial outcomes. This leader will manage teams responsible for hospital and professional fee coding and documentation, ensuring that every clinical encounter is accurately reflected to support quality care, regulatory compliance, and optimal reimbursement.

Key Responsibilities

• Provide strategic leadership for CDI, Coding, and HIM operations across inpatient, outpatient, and professional fee environments to ensure accuracy, integrity, and compliance.
• Oversee professional fee and hospital coding operations, ensuring consistent application of CPT, HCPCS, and ICD-10 coding standards.
• Drive cross-continuum collaboration between CDI, coding, clinical operations, and physician practices to enhance documentation quality and revenue integrity.
• Leverage professional fee expertise to optimize workflows, coding accuracy, and payer compliance for physician and ambulatory services.
• Utilize data-driven decision-making and Lean management principles to improve productivity, reduce variation, and strengthen process efficiency.
• Partner with clinical, IT, and operational leaders to implement a systemwide roadmap for technology-enabled improvements that reduce provider burden and enhance documentation quality.
• Ensure compliance with all federal, state, and payer requirements while maintaining a culture of integrity, accountability, and continuous improvement.
• Serve as the executive sponsor for enterprise HIM and documentation strategy, driving innovation and standardization across the care continuum.

Ideal Candidate Profile

• Proven experience leading revenue cycle, CDI, coding, and HIM functions, including both hospital and professional fee domains, within a large, integrated health system.
• Deep knowledge of professional fee coding and billing, including physician documentation, CPT/HCPCS coding, and payer reimbursement models.
• Demonstrated success in strategic planning, cross-functional collaboration, and process transformation leveraging Lean or similar methodologies.
• Expertise in technology-enabled performance improvement, including automation, AI-assisted coding, and EHR optimization.
• Strong communication and relationship management skills with the ability to engage providers, executives, and operational stakeholders.

This is an exceptional opportunity to join one of the nation's most respected health systems and lead enterprise-level strategy for clinical documentation integrity, coding, and professional fee excellence - ensuring that Scripps continues to deliver the highest quality of care while optimizing financial performance and compliance.

Required Education / Experience / Specialized Skills

• Bachelor's degree in Health Information Management, Business, Finance, or a related healthcare field.
• Minimum of 10 years of progressive experience in healthcare revenue cycle operations, including at least 5 years in senior leadership within a multi-hospital or integrated health system.
• Demonstrated success leading large-scale coding, clinical documentation integrity (CDI) and health information management (HIM) operations.
• Deep knowledge of professional fee and hospital revenue cycle processes, including payer requirements, reimbursement methodologies, and compliance regulations (Federal, State, County, and Commercial).
• Proven experience in operations redesign, process improvement, and project management, with a strong focus on data-driven performance improvement.
• Expertise in clinical documentation integrity program development, physician engagement, and cross-functional collaboration.
• Exceptional analytical, critical-thinking, and communication skills, with the ability to influence at all levels of the organization.

Preferred Education / Experience / Certifications

• Master's degree in Business Administration, Healthcare Administration, Finance, or related field.
• Experience with Epic or other large-scale electronic health record (EHR) and revenue cycle platforms.
• Professional certification(s) through AHIMA or AAPC, such as:
  • RHIA (Registered Health Information Administrator)
  • RHIT (Registered Health Information Technician)
  • CCS (Certified Coding Specialist)
  • CPC (Certified Professional Coder)
• Comprehensive understanding of ICD, CPT, and HCPCS coding systems, MS-DRG/APR-DRG methodologies, and risk adjustment/HCC principles.
• Strong technical proficiency and experience in professional fee/physician services operations, analytics, and reporting.