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Revenue Integrity Manager

The Revenue Integrity Manager is responsible for overseeing revenue validation and financial integrity processes to ensure accurate net patient revenue, regulatory compliance, and optimal reimbursement performance. This role safeguards hospital revenue by analyzing financial, billing, and operational data to identify revenue gaps, contractual variances, and underpayment trends.

The Manager conducts detailed Accounts Receivable (AR) valuations and evaluates net realizable value (NRV) to support accurate reporting and forecasting. Through proactive monitoring of key revenue cycle metrics, including denial rates, AR aging, and net collection rates. This position drives continuous improvement initiatives that enhance financial performance.

In collaboration with Finance, Health Information Management (HIM), clinical departments, and IT, the Revenue Integrity Manager strengthens charge capture accuracy, optimizes reimbursement outcomes, and implements corrective strategies to prevent revenue leakage while ensuring regulatory compliance.

Key Responsibilities

• Oversee revenue validation and financial integrity processes across the hospital.
• Analyze financial, billing, and operational data to identify revenue gaps, contractual variances, and underpayment trends.
• Develop, recommend, maintain and drive KPI benchmarks and indicators for continuous performance improvement.
• Conduct detailed AR valuations and assess net realizable value (NRV) to ensure accurate revenue recognition.
• Support month-end close, revenue reporting, and financial forecasting processes.
• Charge Description Master (CDM) Management
• Oversee maintenance, validation, and optimization of the Charge Description Master (CDM).
• Ensure accurate CPT, HCPCS, modifiers, revenue codes, and pricing updates.
• Coordinate routine CDM reviews to maintain regulatory and payer compliance.
• Collaborate with clinical departments to ensure accurate charge capture workflows.
• Monitor key performance indicators including denial rates, AR aging, net collection rates, and charge lag.
• Perform root cause analysis of denials and underpayments.
• Develop and implement corrective action plans to reduce preventable denials and improve reimbursement.
• Identify trends impacting financial performance and implement process improvements.
• Ensure compliance with Medicare, Medicaid, and commercial payer regulations.
• Support internal and external audits.
• Maintain knowledge of reimbursement methodologies (DRG, APC, etc.).
• Establish internal controls to safeguard revenue and mitigate financial risk.
• Review, assess and establish machine learning and AI as an operational must have in developing state of the art systems, model development and performing root cause analysis.
• Partner with Finance, HIM, Patient Finance, and clinical leadership to strengthen revenue capture.
• Provide education and guidance on revenue integrity best practices.
• Assist with system upgrades, revenue cycle implementations, and workflow optimization.
• Lead or mentor revenue integrity analysts, as applicable.

Required Qualifications

• Bachelor's degree in healthcare administration, Finance, Accounting, Business, or related field (Master's preferred).
• Minimum 5 years of progressive hospital revenue cycle experience.
• Strong knowledge of CDM maintenance, AR valuations, NRV, reimbursement methodologies, and payer regulations.
• Experience with hospital billing systems and EHR platforms.
• Knowledge of CPT, ICD-10, and HCPCS coding structures.
• Strong analytical and problem-solving skills.

Preferred Qualifications

• HFMA (CRCR, CHFP), CCS, CPC, or CPA certification preferred.
• Experience in multi-facility health systems.
• Experience with revenue cycle analytics and reporting dashboards.

Benefits

• Competitive salary
• Health, dental, and vision insurance
• Retirement savings plan with employer match
• Paid time off and holidays
• Professional development support
• Employee wellness programs