Manager, Hospital Revenue Integrity

The Manager Hospital Revenue Integrity is responsible for managing daily revenue integrity operations within assigned hospitals or physician enterprise service lines. This includes overseeing charge capture and reconciliation processes, coordinating billing and coding compliance, and leading initiatives that enhance financial performance. Serving as the key connection between clinical, operational, and finance teams, this role ensures consistent application of revenue integrity practices and supports both proactive and retrospective financial improvement initiatives.

The Manager also plays a dual role by providing financial and analytical insight, identifying trends, investigating variances, and developing recommendations that improve revenue performance. The position contributes directly to system-level initiatives and maintains a close working relationship with hospital/physician operations and Finance Directors.

Revenue Integrity Operations

• Lead charge abstraction, charge capture, reconciliation, and claim edit review processes for assigned clinical departments or entities.
• Supervise daily work queue management and operational tasks to ensure workflow efficiency and compliance.
• Oversee billing and coding follow-up activities and serve as an escalation point for issue resolution.

Financial Analysis & Decision Support

• Review and analyze operational financial trends; highlight variances and recommend corrective actions to clinical and financial leadership.
• Perform cost-benefit analyses and support the preparation of business cases, pro formas, and strategic budget planning.
• Produce reports and dashboards related to revenue performance, productivity, and revenue leakage.

Denials & Audit Support

• Collaborate with the Senior Director and Clinical Denials team to investigate, analyze, and resolve clinical denials.
• Participate in payer audit preparation, response, and corrective action planning related to revenue integrity.
• Monitor denial trends and assist in the design and implementation of prevention strategies.

Liaison & Collaboration

• Act as the on-site or assigned Revenue Integrity Liaison to hospital or physician enterprise leadership, providing regular communication and updates.
• Partner with Finance Directors, clinical department heads, and operational leaders to align on revenue goals, strategies, and outcomes.
• Assist in translating clinical and operational processes into financially sound and compliant charge capture models.

Leadership & Standardization

• Supervise and mentor staff assigned to the revenue integrity function, providing training, guidance, and development opportunities.

• Ensure system-wide standardization of processes, policies, and education across departments.

• Promote best practices, lean workflows, and continuous improvement across all responsibilities.

• Experience:

• Minimum of 5 years of experience in revenue integrity, financial analysis, or healthcare operations.

• Experience with charge capture, CDM, billing/coding, denials, and healthcare reimbursement methodologies.

• Prior experience in hospital or physician revenue cycle strongly preferred.

• Skills & Proficiencies:

• Strong understanding of hospital/professional billing and coding standards (MS-DRG, CPT, HCPCS, ICD-10).

• Proficient in Microsoft Excel and financial reporting tools.

• Demonstrated leadership and organizational skills.

• Effective communicator with ability to influence across functions.

• Analytical mindset with ability to interpret complex data sets.

• Preferred Certifications:

RHIA, CPC, or COC preferred. CPA is a plus.

• Preferred Education: Bachelor's degree in Healthcare Administration, Business, Finance, Accounting, or related field or Master's of Business Administration.