Director, Revenue Integrity Strategy

Healthrise

Director of Revenue Integrity Strategy handling reimbursement integrity and operational improvement across health system. Leading a team to enhance regulatory compliance and financial accuracy.

Posted 6/2/2026full-time🇺🇸 United StatesLeadWebsite

About the role

Key responsibilities & impact

Provide strategic and operational leadership across reimbursement integrity, payment validation, revenue optimization, and payer oversight activities across the health system.
Drive initiatives focused on financial accuracy, reimbursement integrity, operational improvement, and regulatory compliance across the revenue cycle continuum.
Partner with Revenue Cycle, Compliance, Finance, HIM, Managed Care, and Clinical Operations leadership to identify reimbursement trends and improve operational workflows.
Oversee complex payer review activity, reimbursement escalations, external validation requests, and governmental and commercial payer inquiries.
Develop and manage reimbursement resolution strategies including appeals coordination and payer dispute management.
Recruit, lead, and develop a team of revenue integrity analysts and reimbursement specialists; set performance goals and ensure staff education and training.
Ensure all reimbursement integrity and payment review activities comply with CMS regulations, OIG guidance, False Claims Act requirements, and applicable state laws.
Drive identification and resolution of reimbursement variances and payment discrepancies impacting organizational financial performance.
Collaborate with Clinical Documentation Improvement (CDI), Case Management, Coding, and Billing teams to address audit findings.

Requirements

What you’ll need

Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field.
Minimum 7-10 years of progressive experience in healthcare revenue cycle, with at least 5 years focused on post pay audits, claims auditing, or revenue integrity.
Minimum 3-5 years of leadership or management experience overseeing audit or revenue cycle teams.
Demonstrated experience managing RAC, MAC, UPIC, OIG, or commercial payer audit responses and appeals.
Deep knowledge of Medicare and Medicaid billing regulations and expertise in ICD-10, CPT, and HCPCS coding systems.
Proficiency in EMR/EHR systems (Epic, Cerner, Meditech) and understanding of MS-DRG, APC, and RBRVS reimbursement methodologies.
Advanced Excel, data analysis, and reporting skills; familiarity with PEPPER, CERT, and RAC data analytics.
Completion of regulatory/mandatory certifications as required.
Willingness and ability to travel to client or organizational sites as needed.

Benefits

Comp & perks

Health insurance
Professional development opportunities

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

reimbursement integritypayment validationrevenue optimizationfinancial accuracyoperational improvementregulatory complianceclaims auditingICD-10 codingCPT codingHCPCS coding

Soft Skills

strategic leadershipoperational leadershipteam developmentperformance managementcollaborationcommunication

Certifications

regulatory certifications