Revenue Integrity Program Manager Jobs in California

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Department:Patient Financial Services

The Revenue Integrity Coordinator is responsible for supporting the hospital's revenue integrity program by ensuring accurate charge capture, compliant billing practices, reimbursement optimization, and prevention of revenue leakage. This position serves as a liaison between clinical departments, Revenue Cycle, Health Information Management (HIM), Coding, Compliance, Patient Financial Services, and Information Technology to promote accurate documentation, charging, coding, and billing processes. The coordinator conducts audits, analyzes revenue cycle data, identifies process improvement opportunities, supports Chargemaster maintenance, and assists with regulatory compliance initiatives to maximize net patient revenue while maintaining adherence to federal and state regulations.

Revenue Integrity Operations
Perform routine reviews of charge capture processes to ensure accurate and complete revenue recognition.
Monitor charging practices and identify opportunities to improve revenue cycle performance and reduce
revenue leakage.
Investigate and resolve charging, coding, billing, and reimbursement discrepancies.
Analyze claim edits, denials, and payment variances to identify root causes and recommend corrective
actions.
Support revenue recovery initiatives by identifying missed charges and reimbursement opportunities.
Chargemaster Management
Assist with maintenance, validation, and periodic review of the hospital Chargemaster.
Ensure charge descriptions, HCPCS/CPT codes, revenue codes, and pricing structures are accurate and
compliant.
Collaborate with departmental leaders to implement charge updates and service changes.
Participate in Chargemaster audits and testing activities.
Compliance and Audit Support
Conduct revenue integrity audits to evaluate charging accuracy and regulatory compliance.
Support compliance with Medicare, Medicaid, commercial payer, and regulatory requirements.
Revenue Integrity Coordinator
Assist with internal and external audit requests and documentation.
Identify compliance risks and escalate findings appropriately.

Revenue Analysis and Reporting
Collect, analyze, and interpret revenue cycle data to identify trends and performance improvement
opportunities.
Prepare reports related to charge capture, denials, reimbursement variances, and audit findings.
Monitor key performance indicators and communicate findings to leadership.
Assist with financial impact analyses related to revenue integrity initiatives.

Cross-Functional Collaboration
Work closely with clinical departments, Coding, HIM, Finance, Patient Access, and Patient Financial
Services to resolve revenue cycle issues.
Participate in workflow improvement projects designed to enhance revenue capture and billing accuracy.
Assist with implementation of new services, procedures, and system updates affecting charging and
reimbursement.

Education and Support
Provide guidance and education to operational departments regarding charging and documentation
requirements.
Support training efforts related to revenue integrity policies, billing compliance, and charge capture
processes.
Maintain current knowledge of healthcare reimbursement methodologies and regulatory updates.

Education: High school diploma or GED required.

Licensure: None.

Experience: Two (2) years of progressive experience in a revenue integrity capacity within a hospital environment preferred. Five (5) years of experience in healthcare revenue cycle operations required. Demonstrated track record of success in revenue cycle operations. Experience in monitoring and analyzing
revenue cycle trends, variances and opportunities for improvement. Understanding in payer compliance and chargemaster review and maintenance processes.

Pay Range: The hourly rate for this position is $46.70 - $55.00 The range displayed on this job posting reflects the target for new hire salaries for this position.

Job Specifications:

Union: Non-Affiliated Work Shift: Day Shift FTE: 1.0 Scheduled Hours: 40

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