Manager, Revenue Quality

The Manager, Revenue Quality leads enterprise-level efforts focused on audit readiness, quality assurance, and revenue compliance within the hospital revenue integrity domain. This role is a pivotal connector across internal stakeholders and external regulatory bodies, ensuring compliance with internal policies and external requirements from payers, state and federal agencies.

The Manager is responsible for the development and execution of robust internal audit programs and integration of compliance risk mitigation strategies into operational workflows. This leader will proactively monitor audit trends, drive charge integrity initiatives, and equip the organization with timely insights to maintain regulatory alignment and minimize financial exposure.
 

Audit & Quality Assurance

• Design and manage a comprehensive internal audit framework focused on charge capture, coding accuracy, billing integrity, and clinical documentation.
• Oversee audit lifecycle management, including pre-audit preparedness, audit execution, response compilation, and post-audit follow-ups.
• Collaborate with Compliance and Legal departments to identify risk areas and ensure appropriate remediation and reporting.
• Maintain audit logs, analyze audit trends, and escalate systemic risks for leadership visibility.

Workflow & Process Optimization

• Assess and optimize charge capture workflows across service lines to ensure alignment with compliance and reimbursement standards.
• Partner with Revenue Cycle, IT, Clinical, and Finance teams to integrate audit findings into sustainable workflow improvements.
• Implement audit-triggered process changes to mitigate repeat deficiencies and reduce future audit vulnerability.

Compliance Oversight

• Act as the primary compliance liaison between Revenue Integrity and departments responsible for local, state, and federal regulatory adherence.
• Monitor regulatory developments (e.g., CMS updates, OIG Work Plan priorities) and update internal processes and training materials accordingly.
• Support or lead risk assessments, compliance readiness reviews, and enterprise audit response efforts.

Denial Prevention & Risk Mitigation

• Lead denial root cause analysis initiatives related to charge errors, coding discrepancies, and documentation gaps.
• Identify correlations between denial trends and audit outcomes to deploy risk prevention strategies.
• Collaborate with clinical and financial teams to deploy mitigation plans that reduce the likelihood of denied or recouped claims.

Financial & Operational Reporting

• Prepare and present reports related to audit results, denial trends, compliance risks, and financial recovery opportunities.
• Conduct cost-benefit analyses to evaluate the financial impact of audit-related process improvements.
• Provide data-driven insights to Revenue Cycle and Compliance leadership to support strategic planning and resource allocation.

Education & Outreach

• Develop and deliver training programs for hospital departments on compliance best practices, audit protocols, and charge capture accuracy.
• Lead outreach related to audit preparedness, policy changes, and evolving payer or regulatory expectations.
• Support the Charge Integrity Council by translating audit trends and compliance insights into actionable strategies.

Experience:

• Minimum 5 years of experience in healthcare compliance, revenue integrity, audit, or healthcare quality management.
• Demonstrated experience responding to or managing payer, state, or federal audits.
• Knowledge of billing and coding regulations, including CMS guidelines, OIG audit criteria, and payer-specific policies.

Skills & Competencies:

• Advanced analytical and reporting skills, including proficiency in Excel and audit platforms.
• Strong understanding of regulatory environments, including state and federal laws, OIG expectations, and payer contract requirements.
• High-level communication and leadership abilities to influence stakeholders across departments.
• Skilled in developing compliance policies and navigating external audit processes.

Preferred Certifications:

• RHIA, CPC, CHC, COC, or similar credentials preferred. Experience with Epic and audit tracking systems a plus.

Preferred Education:

• Bachelor’s degree in Healthcare Administration, Business, Finance, Accounting, or a related or Master’s degree or advanced certification preferred.

Working Conditions:

• Primarily office-based