Revenue Integrity Manager

Kavi Software Technologies Philippines Corp.; Iloilo; On-site; PHP 1,200,000 - 2,400,000; Full time

Job summary

Kavi Software Technologies Philippines Corp. seeks a Revenue Integrity Manager to oversee charge capture, coding compliance, and denial management across healthcare services.

The role drives accuracy, regulatory adherence, and optimal reimbursement through collaboration with clinical, coding, billing, finance, and IT teams. The ideal candidate has strong revenue cycle expertise, leadership experience, and a track record of improvements using data analytics and cross-functional initiatives to

Qualifications

• Bachelor's degree in Healthcare Administration, Health Information Management, Healthcare Finance, Business Administration, or a related field.
• 5-7+ years of experience in healthcare revenue cycle management, revenue integrity, charge capture, coding, billing, or reimbursement.
• At least 2-3 years of experience in a team leadership or management role.
• Demonstrated experience in revenue integrity audits, charge reconciliation, coding compliance, and reimbursement analysis.
• Experience working with US hospitals, health systems, physician groups, or healthcare RCM service providers is preferred.

Responsibilities

• Oversee charge capture processes to ensure all eligible healthcare services are accurately documented, coded, and billed.
• Manage and maintain the Charge Description Master (CDM), including charge descriptions, codes, and reimbursement-related updates.
• Identify revenue leakage, missed charges, underbilling, and overbilling through systematic reviews and audits.
• Establish controls to improve charge accuracy, completeness, and consistency across departments.
• Partner with clinical and operational teams to resolve charge capture discrepancies.
• Ensure compliance with applicable CMS regulations, payer policies, and coding guidelines, including CPT, HCPCS, and ICD-10-CM.
• Conduct periodic audits of coding, billing, and charge capture processes to identify compliance risks.
• Develop corrective action plans to address audit findings and recurring billing errors.
• Collaborate with compliance and coding teams to implement regulatory and reimbursement policy updates.
• Support internal and external audits and maintain appropriate documentation.
• Analyze denial trends, underpayments, billing discrepancies, and reimbursement variances.
• Identify root causes of revenue loss and implement sustainable corrective actions.
• Collaborate with denial management, accounts receivable, and payment posting teams to resolve reimbursement issues.
• Support payer contract compliance reviews and investigate reimbursement discrepancies.
• Recommend process improvements to minimize avoidable denials and maximize appropriate reimbursement.
• Develop dashboards and reports to monitor revenue integrity performance.
• Establish and track KPIs (charge capture accuracy, revenue leakage, coding & billing accuracy, denial rates, underpayment recovery).
• Use data analytics to identify trends, operational risks, and opportunities for improvement.
• Present performance insights and improvement recommendations to senior leadership.
• Work closely with Coding, Billing, Clinical Operations, Finance, Compliance, Contracting, and IT teams.
• Partner with EHR and billing system teams to improve charge workflows, system configurations, and billing edits.
• Support the implementation of new reimbursement policies, coding updates, and technology solutions.
• Facilitate regular operational reviews to resolve issues and improve revenue cycle outcomes.
• Lead, mentor, and develop revenue integrity professionals.
• Establish performance expectations, quality standards, and productivity targets.
• Conduct regular performance reviews and provide coaching and training.
• Standardize workflows, audit methodologies, and operating procedures.
• Drive continuous improvement initiatives to improve efficiency, accuracy, compliance, and financial outcomes.

Skills

Revenue integrity

Charge capture

Coding compliance

Denial management

Data analytics

Leadership

Education

Bachelor's degree in Healthcare Administration

Bachelor's degree in Health Information Management

Job description

The Revenue Integrity Manager is responsible for ensuring accurate charge capture, coding compliance, billing accuracy, and optimal reimbursement across healthcare services. This role focuses on identifying and preventing revenue leakage, improving revenue cycle performance, maintaining regulatory compliance, and implementing process improvements through collaboration with clinical, coding, billing, finance, and IT teams.

The ideal candidate will have strong healthcare revenue cycle expertise, analytical capabilities, and leadership experience in revenue integrity, charge capture, coding, and reimbursement optimization.

Key Responsibilities

1. A. Revenue Integrity and Charge Capture

   • Oversee charge capture processes to ensure all eligible healthcare services are accurately documented, coded, and billed.

   • Manage and maintain the Charge Description Master (CDM), including charge descriptions, codes, and reimbursement-related updates.

   • Identify revenue leakage, missed charges, underbilling, and overbilling through systematic reviews and audits.

   • Establish controls to improve charge accuracy, completeness, and consistency across departments.

   • Partner with clinical and operational teams to resolve charge capture discrepancies.

   B. Coding, Billing, and Regulatory Compliance

   • Ensure compliance with applicable CMS regulations, payer policies, and coding guidelines, including CPT, HCPCS, and ICD-10-CM.

   • Conduct periodic audits of coding, billing, and charge capture processes to identify compliance risks.

   • Develop corrective action plans to address audit findings and recurring billing errors.

   • Collaborate with compliance and coding teams to implement regulatory and reimbursement policy updates.

   • Support internal and external audits and maintain appropriate documentation.

2. C. Denial Management and Reimbursement Optimization

• Analyze denial trends, underpayments, billing discrepancies, and reimbursement variances.

• Identify root causes of revenue loss and implement sustainable corrective actions.

• Collaborate with denial management, accounts receivable, and payment posting teams to resolve reimbursement issues.

• Support payer contract compliance reviews and investigate reimbursement discrepancies.

• Recommend process improvements to minimize avoidable denials and maximize appropriate reimbursement.

D. Data Analytics and Performance Management

• Develop dashboards and reports to monitor revenue integrity performance.

• Establish and track key performance indicators (KPIs), including:

  • Charge capture accuracy and completeness.

  • Revenue leakage and missed-charge trends.

  • Coding and billing accuracy.

  • Denial rates attributable to charge or coding errors.

  • Underpayment identification and recovery.

  • Audit compliance and corrective action closure.

• Use data analytics to identify trends, operational risks, and opportunities for improvement.

• Present performance insights and improvement recommendations to senior leadership.

E. Cross-Functional Collaboration

• Work closely with Coding, Billing, Clinical Operations, Finance, Compliance, Contracting, and IT teams.

• Partner with EHR and billing system teams to improve charge workflows, system configurations, and billing edits.

• Support the implementation of new reimbursement policies, coding updates, and technology solutions.

• Facilitate regular operational reviews to resolve issues and improve revenue cycle outcomes.

F. Team Leadership and Process Improvement

• Lead, mentor, and develop revenue integrity professionals.

• Establish performance expectations, quality standards, and productivity targets.

• Conduct regular performance reviews and provide coaching and training.

• Standardize workflows, audit methodologies, and operating procedures.

• Drive continuous improvement initiatives to improve efficiency, accuracy, compliance, and financial outcomes.

Must have:

• Bachelor's degree in Healthcare Administration, Health Information Management, Healthcare Finance, Business Administration, or a related field.

• 5-7+ years of experience in healthcare revenue cycle management, revenue integrity, charge capture, coding, billing, or reimbursement.

• At least 2-3 years of experience in a team leadership or management role.

• Demonstrated experience in revenue integrity audits, charge reconciliation, coding compliance, and reimbursement analysis.

• Experience working with US hospitals, health systems, physician groups, or healthcare RCM service providers is preferred.

One or more of the following certifications are preferred:

• Certified Professional Coder (CPC).

• Certified Outpatient Coder (COC).

• Certified Coding Specialist (CCS).

• Certified Professional Medical Auditor (CPMA).

• Registered Health Information Administrator (RHIA).

• Registered Health Information Technician (RHIT).

• HFMA Certified Revenue Cycle Representative (CRCR).

Nice to have:

• Experience supporting US healthcare providers, including hospitals, health systems, and physician practices.

• Familiarity with Medicare, Medicaid, and commercial payer reimbursement policies.

• Experience with hospital or professional billing revenue integrity.

• Exposure to revenue cycle analytics, automation, and AI-enabled audit solutions.

• Experience leading cross-functional improvement initiatives in a multi-site or global delivery environment.

• A relevant master's degree is preferred but not mandatory.