Revenue Integrity Manager

Summary

Responsible for operational and strategic oversight of the Revenue Integrity team, including oversight of billing compliance, charge capture, and revenue analysis. The Manager, Revenue Integrity partners with revenue-producing departments regarding lost charges, billing questions, and proper coding and charging practices while ensuring compliance, documentation integrity, and revenue optimization.

Key Responsibilities

• Provide leadership and supervision to the Revenue Integrity and/or CDM team.

• Ensure effective collaboration between providers, coders, and billers to support compliant documentation and optimal coding outcomes.

• Collaborate with clinical providers to enhance documentation quality and accuracy, supporting compliant billing, appropriate risk stratification, and accurate Uniform Data System (UDS) reporting.

• Conduct routine internal audits and chart reviews to monitor accuracy, identify trends, and implement corrective actions supporting compliance and data integrity.

• Maintain current knowledge of federal, state, and payer coding regulations and update internal protocols and workflows to ensure compliance and operational consistency.

• Monitor productivity, accuracy, and quality metrics; develop and implement performance improvement plans to meet departmental and organizational benchmarks.

• Collaborate with billing, clinical, quality, and compliance teams to enhance communication, improve documentation workflows, and ensure alignment between coding practices and organizational goals.

• Review high-volume accounts assigned to Revenue Integrity work queues for charge review and charge entry, including observation accounts, procedure carve-out reviews, extended recovery carve-out time, injection and infusion charges, and related activities.

• Analyze inpatient and outpatient records for appropriate charging, coding reviews (NCCI edits, MUE edits, medical necessity edits), and denials.

• Serve as a resource to hospital departments regarding charging questions, audits, billing issues, and educational opportunities.

• Maintain established productivity requirements and a 95% or greater accuracy rate.

Leadership Responsibilities

This position provides direct oversight and management of the Revenue Integrity function and supervises the following roles:

• Revenue Integrity Specialist

• RN Auditor

Key leadership responsibilities include:

• Hiring, onboarding, training, and developing team members

• Performance management, coaching, and employee evaluations

• Scheduling and workforce planning

• Employee relations and corrective action administration

• Work allocation and prioritization

• Budget planning and departmental resource management

• Policy enforcement and compliance oversight

• Ensuring a safe and secure work environment

Minimum Qualifications

Education

Bachelor's Degree in Healthcare Administration, Business Administration, Finance, Accounting, or a related field required.

Four (4) additional years of relevant work experience may be accepted in lieu of a bachelor's degree.

Experience

• Three (3) years of management experience within Revenue Cycle, Acute Care, or Health Information Management required.

• Five (5) years of revenue analysis, charging, auditing, or coding experience in an acute care setting required.

Preferred Education

• Master's Degree

Licenses/Certifications

• Candidates with a nursing degree must maintain an active, unrestricted nursing license and/or obtain a Certified Professional Coder (CPC) credential within six (6) months of hire.

• Candidates with education or degrees in other disciplines must obtain a CPC credential within six (6) months of employment.