Revenue Cycle Managed Services - Revenue Integrity Lead

Accountabilities:

Revenue integrity leadership: Lead and manage consulting engagements focused on revenue integrity, revenue optimization, charge capture, reimbursement accuracy, and revenue cycle transformation for hospitals, health systems, physician groups, and other healthcare providers.
Revenue cycle assessment: Conduct comprehensive evaluations of revenue cycle operations, billing practices, charge capture workflows, and reimbursement processes to identify performance gaps, financial risks, and opportunities for improvement.
Revenue optimization and recovery: Identify revenue leakage and lead initiatives to improve charge capture, enhance clinical documentation collaboration, reduce denials, increase billing accuracy, accelerate cash flow, and maximize appropriate reimbursement.
Financial analysis and performance monitoring: Analyze charge master data, pricing methodologies, payer contract performance, reimbursement trends, claims, denials, and utilization data. Develop KPI dashboards, benchmarking frameworks, and monitoring strategies to track results.
Compliance and regulatory oversight: Evaluate charging and billing practices against Medicare, Medicaid, commercial payer requirements, and applicable regulations. Identify audit risks, recommend corrective actions, and support audit preparation, remediation, and revenue integrity governance.
Strategic consulting and client engagement: Serve as a trusted advisor to healthcare executives and operational leaders. Facilitate workshops, present findings, lead strategic planning sessions, and develop implementation roadmaps that align with client objectives.
Project management and delivery: Develop project plans, coordinate multidisciplinary teams, manage timelines, and ensure the successful delivery of revenue improvement and transformation initiatives.
Technology optimization: Recommend enhancements to electronic health records (EHRs), billing systems, and revenue cycle platforms to improve workflows, data quality, operational efficiency, and financial performance.
Team leadership and knowledge sharing: Mentor consultants, analysts, and other team members on revenue integrity best practices. Contribute to consulting methodologies, thought leadership, solution development, and business development activities, including proposals and client presentations.
Requirements:
Industry-relevant certification in healthcare revenue integrity, such as Certified in Healthcare Revenue Integrity (CHRI), Certified Revenue Integrity Professional (CRIP), or an equivalent credential.
At least 8 years of experience in healthcare revenue cycle management, including a minimum of 5 years of direct experience in revenue integrity, revenue cycle consulting, revenue optimization, or related healthcare financial operations.
Demonstrated experience leading complex healthcare improvement initiatives and delivering measurable financial or operational results.
Strong expertise in revenue integrity programs, charge capture, chargemaster (CDM) management, denial management, revenue recovery, revenue cycle operations, and revenue compliance.
Comprehensive knowledge of Medicare and Medicaid reimbursement, commercial payer reimbursement practices, and relevant regulatory requirements.
Familiarity with clinical documentation improvement concepts and their relationship to appropriate reimbursement and revenue integrity.
Advanced analytical and problem-solving skills, including the ability to interpret complex financial and operational data, identify revenue opportunities, and develop practical recommendations.
Excellent executive communication and presentation skills, with the ability to explain complex findings, influence stakeholders, and build trusted client relationships.
Strong project management, leadership, and collaboration skills, including experience coordinating clinical, finance, revenue cycle, compliance, and IT stakeholders.
Preferred qualifications:
A bachelor's or master's degree in Healthcare Administration (MHA), Business Administration (MBA), Finance, or a related discipline.
Previous experience working within a healthcare management consulting firm.
Additional professional certifications, including those offered by the Healthcare Financial Management Association (HFMA).
Experience with healthcare technology platforms such as Epic, Cerner, Oracle Health, or MEDITECH.
Experience supporting large integrated delivery networks, academic medical centers, or complex healthcare systems.
Demonstrated ability to contribute to business development, consulting solution design, and the development of scalable revenue integrity methodologies.
Benefits:
Performance-based compensation: Eligibility for an annual performance bonus may be available for salaried positions, subject to applicable employment terms.
Additional benefits and perks: Other benefits may be available depending on the position and the terms of employment.
Remote work flexibility: Fully remote position based in the United States.
Professional development: Opportunities to strengthen expertise in healthcare revenue integrity, financial optimization, consulting, and revenue cycle transformation.
Leadership opportunities: The ability to mentor professionals, contribute to consulting methodologies, and influence strategic initiatives across healthcare organizations.
Meaningful impact: Help hospitals and healthcare providers improve financial sustainability, strengthen compliance, and optimize revenue cycle performance.
Collaborative culture: Work alongside multidisciplinary professionals in a supportive environment that values integrity, accountability, autonomy, and teamwork.
Inclusive workplace: A commitment to diversity, inclusion, and ensuring that employees feel valued and empowered.
Career advancement: Opportunities to contribute to thought leadership, business development, and innovative healthcare consulting solutions.