Manager, Revenue Integrity

Overview:

Provides strategic leadership and technical oversight for the Revenue Integrity Department. Ensures accurate, complete, and timely charge capture and reconciliation, optimizes reimbursement, and safeguards compliance with all regulatory standards. Leads key operational initiatives across nurse auditing, coding, Charge Description Master (CDM) maintenance, and denials management, while fostering collaboration with clinical, financial, and operational teams. Through innovative strategies and continuous process improvement, this position enhances revenue cycle performance and supports organizational financial health. Leadership and Oversight: Supervise and mentor the Revenue Integrity teams, including nurse auditors, coders, analysts and specialists. Monitor performance metrics and implement continuous improvement strategies. Conduct performance evaluations and support professional development for direct reports. Charge Capture and Systems Management: Oversee the development and execution of revenue integrity initiatives to optimize charge capture and reimbursement. Manage EHR Revenue Cycle systems and other billing platforms to ensure accurate and timely charge capture. Direct and support CDM maintenance and revenue integrity analytics, to include collaboration with managed care team and finance for pricing oversight. Research, evaluate, and interpret regulatory and payor guidance to assess facility impact, ensuring compliance and maximizing revenue performance. Monitor and evaluate billing and coding updates impacting CDM and Charge capture processes to ensure accurate claim submission, appropriate distribution of information, and identify opportunity areas for education. Compliance and Audit: Ensure adherence to federal, state, and payor-specific regulations, lead internal audits and process reviews to identify revenue leakage and compliance risks. Collaborate with clinical, financial, and operational stakeholders to ensure alignment and compliance with regulatory requirements. Revenue Optimization: Develop, execute, and manage denial prevention and resolution strategies. Provide actionable analytics and key performance indicators (KPI's) to executive leadership, driving alignment with financial objectives and identifying opportunities for improvement. Stakeholder Collaboration: Engage and collaborate with clinical and ancillary leadership to drive charge capture excellence by monitoring KPIs, implementing process improvements, proactively managing denial and audit risks, and delivering targeted education that supports organizational revenue integrity. Serve as a liaison for denials and avoidable write-off committee. Policy and Documentation: Develop operational policies, procedures, and training documentation for the Revenue Integrity efforts with organizational priorities. Promote and emulate a patient-centric and customer service-oriented culture. Community Engagement: Represent the department in community and agency events as appropriate.

 

**Eligible remote states include NC, FL, GA, SC, SD, TN, TX and VA.**

Department Description:

Serving the community since 1961, WakeMed Health & Hospitals is the leading provider of health services in Wake County. With a mission to improve the health and well-being of our community, we are committed to providing outstanding and compassionate care. For more information, visit .
EOE

Licensure: Certified Professional Coder Preferred Registered Health Information Administrator Preferred Certified Coding Specialist Preferred Registered Health Information Technician Preferred Project Management Professional Preferred Education: Bachelor's Degree Healthcare Or Accounting Or Finance Required Experience: 3 Years Leadership Required 1 Year Project Management Required 5 Years Healthcare Required 7 Years Health Information Management Preferred 7 Years Accounting/Finance - Revenue Cycle Preferred