[Hiring] Director - Revenue Integrity @Stanford Health Care

Role Description

The Director of Revenue Integrity delivers enterprise strategic and operational leadership to drive accurate, compliant, and optimized revenue capture across inpatient, outpatient, professional (faculty practice), and research-related services. This role is accountable for preventing revenue leakage and compliance risk through standardized charge capture, pricing governance, CDM management, revenue reconciliation, and analytics. The Director serves as the liaison between Revenue Cycle, clinical departments, and the School of Medicine.

The Director partners closely with clinical departments, School of Medicine leaders and physicians, Advanced Practice Providers (APPs), Coding, Office of Compliance and Privacy, Patient Financial Services, Professional Billing, Finance, Managed Care Contracting, and Technology and Digital Solutions (TDS) to ensure that charging and billing processes are transparent, auditable, and aligned with organizational financial and regulatory objectives.

What you will do

• Lead enterprise Charge Description Master (CDM) Governance, maintenance, and continuous improvement, ensuring accuracy, clarity, and regulatory compliance.
• Establish revenue cycle reporting requirements to meet the needs and expectations of all constituencies.
• Maintain the Hospital’s charge description master (CDM) by incorporating new charges/services.
• Assist in the resolution of problems causing payer denial or failed Medicare edits.
• Work collaboratively with revenue producing department staff, physicians, and School of Medicine (SOM).
• Foster partnering relationships with the Office of Compliance and Privacy, Patient Financial Services, and other third parties.
• Oversee efforts to ensure timely response and compliance with regulatory agencies.
• Educate hospital departments and physicians regarding the charge master and charging philosophy.
• Ensure timely review of regulatory literature and implement necessary changes.
• Coordinate with Patient Financial Services, Professional Billing Office, and Coding for accuracy and compliance.
• Ensure ongoing accuracy and integrity of the CDM and professional fee schedule.
• Identify services that are reimbursable but not being charged; review, assign, and validate codes.
• Facilitate positive communication and build strong relationships regarding revenue cycle matters.
• Participate in Managed Care Contracting Committee with active involvement in pricing and contracting strategy decisions.
• Participate in various TDS-related steering committees for information technology changes.
• Establish performance goals and expectations relevant to both hospital and professional revenue cycle.
• Develop and produce executive and board level Revenue Capture dashboard reporting.
• Plan and schedule annual audit of selected hospital departments.
• Manage and monitor the performance of external vendors providing CDM related products and services.
• Design, analyze, and implement information and reporting systems to monitor revenue cycle performance.
• Oversee the Revenue Integrity Program Managers performing daily CDM operations and updates.
• Collaborate with Strategic Pricing in Finance on pricing alignment.
• Ensure timely adoption of CPT/HCPCS, revenue code, and CMS regulatory updates.
• Oversee charge configuration, testing, and EHR integration of new items and services.
• Support audit readiness and resolve CDM-related compliance issues.
• Lead process improvement initiatives to improve charge accuracy, workflow efficiency, and revenue integrity.
• Develop, track, and report KPIs related to CDM performance and charge accuracy.

Qualifications

• Bachelor’s degree from an accredited college or university with a major in business administration, health care administration, or a related field is required.

Requirements

• Seven (7) years of progressively responsible and directly related work experience.
• Proven progressive leadership experience in revenue integrity, CDM management, charge capture, or healthcare finance.
• Demonstrated leadership experience managing teams and complex, cross-functional initiatives.
• Strong knowledge of healthcare reimbursement, revenue cycle workflows, and regulatory requirements.
• Membership in the Healthcare Financial Management Association (HFMA), National Association Healthcare Revenue Integrity (NAHRI), or American Health Information Management Association (AHIMA) preferred.

Required Knowledge, Skills and Abilities

• Knowledge of all aspects of healthcare revenue cycle functions, including registration, coding and documentation standards, billing and collection processes, as well as government and payer regulations.
• Knowledge of CMS regulations, medical terminology, and the various data elements associated with the UB-04 and CMS-1500 claim form.
• Knowledge of medical records, hospital bills, and service item master.
• Knowledge of principles and practices of organization, administration, fiscal and personnel management.
• Knowledge of local, state, and federal regulatory requirements related to the functional area.
• Ability to conduct and interpret qualitative and quantitative analysis, financial analysis, healthcare economics, and business processes.
• Ability to manage, organize, prioritize, multi-task, and adapt to changing priorities.
• Ability to provide leadership and influence others.
• Ability to foster effective working relationships and build consensus.
• Ability to mediate and resolve complex problems and issues.
• Ability to develop long-range business plans and strategy.

Licenses and Certifications

• Certified Healthcare Revenue Integrity - CHRI required Upon Hire or
• CPC - Certified Professional Coder required Upon Hire or
• CCS - Certified Coding Specialist required Upon Hire or
• RHIT - Registered Health Information Technician required Upon Hire or
• RHIA - Registered Health Information Administrator required Upon Hire

Benefits

• SHC Commitment to Providing an Exceptional Patient & Family Experience.
• Equal Opportunity Employer - SHC strongly values diversity and is committed to equal opportunity and non-discrimination in all policies and practices.
• Base Pay Scale: Generally starting at $83.98 - $111.27 per hour.