General Manager, Revenue Integrity Solutions

Job Purpose
The General Manager, Revenue Integrity Solutions is responsible for the overall leadership, strategy, growth, and operational performance of the Company’s revenue integrity solutions focused on the management, integrity, and optimization of health insurance charge master data. The General Manager, Revenue Integrity Solutions leads a multidisciplinary team responsible for maintaining accurate, complete, compliant, and reliable information that supports healthcare reimbursement, claims processing, pricing, billing, and financial operations.

The General Manager, Revenue Integrity Solutions serves as the primary business leader for the revenue integrity solutions, balancing client needs, operational excellence, technology capabilities, data integrity, financial performance, and continuous improvement. The General Manager, Revenue Integrity Solutions partners closely with healthcare organizations, technology teams, revenue cycle professionals, data analysts, and internal business leaders to ensure the solution delivers measurable value and maintains a high level of data quality and reliability.

Duties & Responsibilities

• Develop and execute the strategic vision and business plan for revenue integrity solutions business
• Establish short- and long-term business objectives aligned with organizational strategy and market opportunities
• Partner with technology and product teams to establish the roadmap with technology and product teams for charge master technology solutions
• Own the overall performance of the business, including revenue, profitability, operational efficiency, client satisfaction, and growth.
• Identify opportunities to expand services, enhance technology capabilities, and develop new solutions addressing evolving healthcare reimbursement and data management needs
• Oversee the development and enhancement of automated tools, workflows, analytics, and reporting capabilities supporting charge master management
• Ensure technology solutions are scalable, secure, reliable, and aligned with healthcare industry requirements
• Establish appropriate controls around system changes, data integrations, releases, and production processes
• Establish and maintain data governance standards, controls, policies, and procedures for the organization’s suite of products and services
• Oversee processes for validating charge master data, including pricing, codes, descriptions, effective dates, payer requirements, reimbursement information, and related attributes
• Present business performance, opportunities, risks, and strategic recommendations to executive leadership
• Support sales and business development efforts by serving as a subject matter expert and demonstrating the value of the organization’s revenue integrity solutions
• Other duties as assigned
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• Bachelor’s degree in Healthcare Administration, Business Administration, Information Technology, Health Information Management, Finance or a related field preferred
• 10+ years of progressive leadership experience in healthcare, healthcare technology, revenue cycle management, healthcare data, payer/provider operations, or a related field
• Demonstrated experience leading a business unit, product, technology solution, or healthcare services organization
• Strong understanding of healthcare reimbursement, charge master management, healthcare pricing, claims, coding, or revenue cycle processes
• Demonstrated experience managing data quality, data governance, or technology-enabled healthcare solutions
• Proven financial and operational management experience
• Demonstrated ability to lead cross-functional teams and manage complex client relationships
• Experience working with hospitals and health systems preferred
• Experience with healthcare pricing, reimbursement methodologies, CPT/HCPCS, revenue codes, APCs, DRGs, or other healthcare payment methodologies a plus
• Experience implementing or managing healthcare data management platforms preferred
• Experience with data analytics, automation, artificial intelligence, or machine learning applications in healthcare preferred
• Experience with SaaS or technology-enabled healthcare services a plus
• Knowledge of HIPAA and healthcare data privacy and security requirements a plus
• Strong analytical and strategic skills
• Proficiency in Microsoft Office Suite
• Strong interpersonal skill