Director

Position Summary:

The Director of Revenue Integrity provides strategic and operational leadership for the University of Tennessee Medical Center's revenue integrity function and is responsible for assuring the accurate, complete, compliant, and timely capture of revenue across the organization.

Reporting to the Vice President of Revenue Cycle, the Director will lead the development and execution of an enterprise-wide revenue integrity strategy designed to optimize reimbursement, prevent revenue leakage, strengthen regulatory compliance, improve charge capture and reconciliation, and support the financial performance of the organization.

The Director serves as a key liaison among Revenue Cycle, Finance, clinical departments, Health Information Management, Coding, Compliance, Information Technology, Managed Care, Patient Financial Services, and operational leadership.

The position requires a leader who combines deep technical knowledge of healthcare revenue cycle and reimbursement with strong analytical, operational, communication, and leadership capabilities.

Organizational Environment

The University of Tennessee Medical Center is a 710-bed, not-for-profit academic medical center and serves as a major tertiary referral center for East Tennessee, Southeastern Kentucky, and Western North Carolina.

UT Medical provides a highly complex continuum of inpatient, outpatient, emergency, surgical, diagnostic, and physician services. The organization includes a Level I Trauma Center, dedicated Heart Hospital, Cancer Institute, transplant services, Comprehensive Stroke Center, regional perinatal and neonatal services, advanced surgical and procedural services, primary and specialty physician practices, and an expanding network of regional and ambulatory locations.

This breadth and complexity require an effective Revenue Integrity function capable of supporting high-acuity hospital services, sophisticated procedural and diagnostic services, ambulatory operations, and potentially professional/physician billing.

Primary Purpose

The Director of Revenue Integrity is responsible for developing, implementing, and continuously improving systems and processes that ensure all billable services are accurately documented, captured, coded, priced, reconciled, and submitted for reimbursement in accordance with payer requirements and applicable federal and state regulations.

The Director will identify opportunities to improve net revenue realization while simultaneously protecting the organization from compliance risk, inaccurate billing, avoidable denials, inappropriate write-offs, and revenue leakage.

Key Responsibilities

Revenue Integrity Strategy and Leadership

• Develop and execute the organization's overall Revenue Integrity strategy in alignment with Revenue Cycle, Finance, Compliance, and operational objectives.

• Establish standards, policies, controls, and accountability for revenue integrity across the organization.

• Develop short- and long-term objectives for improving charge capture, reimbursement, compliance, and revenue realization.

• Identify systemic revenue-cycle issues and lead multidisciplinary initiatives to resolve root causes rather than simply correcting individual transactions.

• Serve as the organization's subject matter expert regarding revenue integrity, charge capture, charge reconciliation, and related reimbursement matters.

• Regularly communicate findings, opportunities, risks, and performance results to the Vice President of Revenue Cycle and other senior leaders.

Charge Capture and Revenue Reconciliation

• Provide oversight for processes designed to ensure complete, accurate, and timely capture of all billable services.

• Establish and maintain systematic charge reconciliation processes across clinical and ancillary departments.

• Identify potential missed charges, incorrect charges, duplicate charges, late charges, and other sources of revenue leakage.

• Partner with clinical and operational leaders to improve charging workflows at the point of service.

• Develop controls and monitoring processes to ensure that new clinical services, technologies, medications, supplies, procedures, and programs are appropriately incorporated into charging and billing processes.

• Evaluate manual processes and identify opportunities for automation and workflow improvement.

Charge Description Master / Chargemaster

• Provide leadership and governance for the organization's Charge Description Master (CDM).

• Ensure CDM accuracy, completeness, consistency, and compliance with applicable coding, billing, regulatory, and payer requirements.

• Establish processes for periodic and ongoing CDM review and maintenance.

• Ensure new services, procedures, supplies, pharmaceuticals, devices, and technologies are accurately established within the CDM.

• Coordinate annual CPT, HCPCS, regulatory, reimbursement, and other coding-related updates affecting charge capture and billing.

• Partner with Finance, Managed Care, Compliance, Coding/HIM, Pharmacy, Supply Chain, IT, and clinical departments regarding CDM changes.

Pricing and Reimbursement

• Participate in development, implementation, and ongoing evaluation of organizational pricing strategies.

• Evaluate charge structures and reimbursement implications across services and departments.

• Partner with Finance and Managed Care to understand payer reimbursement methodologies and their relationship to charging, coding, documentation, and billing processes.

• Identify opportunities to improve appropriate reimbursement while maintaining regulatory and contractual compliance.

• Monitor changes in Medicare, Medicaid, commercial payer, and other reimbursement requirements and translate those changes into operational processes.

Coding, Billing, and Documentation Integrity

• Work closely with Health Information Management, Coding, Clinical Documentation Integrity, Patient Financial Services, and clinical operations to ensure alignment among clinical documentation, coding, charges, and claims.

• Identify coding-, documentation-, and charge-related patterns that negatively affect reimbursement or create compliance risk.

• Establish processes for resolving recurring billing edits and claim errors at their source.

• Collaborate with Coding and Compliance leadership regarding CPT, HCPCS, ICD-10-CM/PCS, modifiers, medical necessity, National and Local Coverage Determinations, and other coding and billing requirements.

• Support education of clinical and operational staff regarding documentation and charging requirements.

Denial Prevention and Revenue Leakage

• Develop Revenue Integrity strategies targeted at preventing avoidable denials before claims are submitted.

• Analyze denial trends to identify root causes associated with charging, coding, documentation, authorization, medical necessity, billing edits, or clinical workflows.

• Partner with Denials Management, Patient Financial Services, HIM/Coding, Patient Access, Managed Care, and clinical departments to develop corrective action plans.

• Identify preventable write-offs and revenue leakage and establish processes for reducing recurrence.

• Quantify revenue opportunities and measure the financial impact of corrective initiatives.

Regulatory Compliance

• Ensure Revenue Integrity processes are conducted in accordance with CMS regulations, federal and state requirements, payer policies, and organizational compliance standards.

• Partner closely with Compliance and Internal Audit to identify and mitigate billing and reimbursement risks.

• Coordinate or support revenue integrity audits and monitoring activities.

• Assist in responding to regulatory changes affecting billing, coding, charging, reimbursement, and clinical documentation.

• Ensure corrective actions are implemented when compliance risks or process deficiencies are identified.

Analytics and Performance Management

• Establish key performance indicators and dashboards for Revenue Integrity.

• Analyze operational and financial data to identify revenue opportunities, compliance issues, reimbursement trends, and process deficiencies.

• Develop reporting that enables clinical and operational leaders to understand Revenue Integrity performance within their departments.

• Monitor such measures as charge lag, late charges, missing charges, billing edits, denial trends, reconciliation variances, DNFB/CFB where applicable, avoidable write-offs, and identified/recovered revenue.

• Measure the financial and operational impact of Revenue Integrity initiatives.

Technology and Process Improvement

• Partner with Information Technology and Revenue Cycle systems teams to optimize EHR and revenue-cycle functionality supporting charge capture, billing, coding, edits, reconciliation, and reporting.

• Evaluate existing workflows and identify opportunities for automation, standardization, and process redesign.

• Participate in implementation and optimization of technology affecting Revenue Integrity.

• Ensure system changes are appropriately tested before implementation and monitored following implementation.

• Leverage data analytics, automation, and emerging technologies to improve accuracy, efficiency, compliance, and financial performance.

Clinical and Operational Partnership

• Develop strong working relationships with physicians, nursing leaders, department directors, clinical service-line leaders, and other operational stakeholders.

• Translate complex reimbursement and regulatory requirements into understandable operational practices.

• Assist departments in evaluating the Revenue Integrity implications of new programs, procedures, technologies, and service lines.

• Provide education regarding charging, documentation, coding, billing, and reimbursement requirements.

• Create a culture in which Revenue Integrity is viewed as a shared organizational responsibility rather than solely a Revenue Cycle function.

Staff Leadership and Development

• Recruit, develop, lead, and retain a high-performing Revenue Integrity team.

• Establish clear accountabilities, performance standards, and professional-development expectations.

• Develop subject-matter expertise within the department in areas such as charge capture, CDM management, auditing, reimbursement, billing edits, and data analytics.

• Promote collaboration, continuous improvement, accountability, and service excellence.

• Determine appropriate organizational structure and staffing based on the ultimate scope of Revenue Integrity responsibilities.

Position Qualification:

Education

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, Health Information Management, Nursing, or another related field required.

• An equivalent combination of highly relevant education and experience may be considered if consistent with UT Medical's employment policies.

Experience

• Minimum of approximately 8-10 years of progressively responsible healthcare revenue cycle, revenue integrity, reimbursement, coding/HIM, charge capture, or closely related experience.

• Minimum of approximately 3-5 years of progressive leadership/management experience.

• Significant experience within an acute-care hospital or health-system revenue-cycle environment required.

• Demonstrated experience leading Revenue Integrity functions, programs, or significant enterprise Revenue Integrity initiatives.

• Demonstrated experience improving charge capture, reimbursement, billing accuracy, denial prevention, or revenue realization.

Required Knowledge

Candidates should demonstrate strong working knowledge of:

• Hospital revenue-cycle operations.

• Revenue Integrity principles and practices.

• Charge capture and reconciliation.

• Charge Description Master management.

• Hospital billing and reimbursement.

• Medicare, Medicaid, and commercial payer requirements.

• CMS billing and reimbursement regulations.

• CPT, HCPCS, ICD-10 and modifier concepts.

• UB-04 institutional claims.

• Revenue-code requirements.

• Clinical documentation and its relationship to charging and reimbursement.

• Claim edits and billing-validation processes.

• Denial prevention and root-cause analysis.

• Regulatory and billing compliance.

• Revenue-cycle analytics and performance measurement.

• EHR and patient-accounting/revenue-cycle systems.