Director, Revenue Integrity

If you are an existing employee of South Shore Health then please apply through the internal career site.

Requisition Number:

R-21372

Facility:

LOC0014 - 549 Columbian Street549 Columbian Street Weymouth, MA 02190

Department Name:

SHS Revenue Cycle

Status:

Full time

Budgeted Hours:

40

Shift:

Day (United States of America)

The Director of Revenue Integrity provides strategic and operational leadership for hospital charge capture, charge integrity, reimbursement analytics, denial and payment variance management. This role oversees enterprise charge reconciliation processes, charge audits, CDM (Charge Description Master) governance, charge edit optimization, payer variance resolution, and business intelligence initiatives in support of the health system’s revenue cycle. The Director serves as a subject matter expert in Epic-based charge capture, reimbursement methodologies, and payer policies, ensuring optimal revenue performance, compliance with regulatory requirements, and alignment with organizational financial goals.

 

Compensation Pay Range:

$145,000.00 - $210,300.00

 

Job Responsibilities:
 

•    Provide leadership for enterprise charge capture, reconciliation, and integrity processes across hospital and professional departments, ensuring accurate and compliant billing.
•    Oversee ongoing review and maintenance of the Charge Description Master (CDM), partnering with clinical, compliance, and financial leaders to align coding, pricing, and charging practices with regulatory standards.
•    Lead charge audit initiatives to identify gaps, missed charges, duplicate charges, and opportunities for improved revenue integrity.
•    Manage and optimize Epic charge capture workflows, charge router edits, and charge review edits to support efficiency, accuracy, and compliance.
•    Direct analysis and resolution of payer reimbursement variances, collaborating with Patient Financial Services, Managed Care, and contracting teams.
•    Partner with Patient Financial Services, Finance, and Clinical Operations teams to evaluate the financial impact of reimbursement changes, payer policy updates, and charge capture initiatives.
•    Lead the design, development, and delivery of revenue cycle business intelligence reports, dashboards, and analytics tools to support informed decision-making.
•    Collaborate with hospital and physician leadership to implement charge capture best practices, education, and policy standardization across the enterprise.
•    Ensure timely monitoring, reporting, and resolution of charge and reimbursement issues identified through audits, variance reporting, or regulatory changes.
•    Develop and mentor a team responsible for charge integrity, CDM, charge edits, and reimbursement analytics.
•    Stay abreast of industry trends, CMS regulations, and payer policy changes, ensuring organizational readiness and proactive response to reimbursement challenges.
•    Prepare for and respond to audits, mitigating risk, and ensuring defensible billing practices.
•    Manage vendor relationships, negotiate contracts, and oversee service-level agreements
•    Collaborate with IT, clinical operations, and external partners to ensure seamless integration and workflow efficiency
•    Validate and respond to state reporting through CHIA
•    Establish revenue cycle informatics team for education on charge capture and reconciliation
•    Monthly reports on denials for hospital and professional billing, analyzing trends and communicating back to charging departments
•    Report on denial trends for all types including but not limited to level of care, medical necessity, authorization, etc.
 

Job Requirements:

Minimum Education

Bachelor's degree preferred in related field, high school diploma required

Minimum Work Experience

7-10 years of progressive revenue cycle, reimbursement or revenue integrity leadership experience in a hospital or health system environment

Knowledge Skills and Abilities required:

• In-depth knowledge of Epic EMR charge capture, CDM, charge router, and reporting tools required.
• Strong understanding of reimbursement methodologies, payer contracting, and revenue cycle operations.
• Demonstrated success in leading cross-functional teams, implementing charge integrity programs, and leveraging analytics to drive performance.
• Strong leadership skills to motivate cross-functional teams’ performance toward excellence using team concepts and consensus-building management styles.
• Effective organizational skills and ability to manage multiple initiatives simultaneously.