Director, Revenue Integrity & Coding (Remote)

Boston Children's Hospital; Westwood (MA); Remote; USD 240,000 - 320,000; Full time

Benefits offered by this job

Health insurance

Retirement plan

Tuition reimbursement

Paid time off

Job summary

Boston Children's Hospital is seeking a Director of physician revenue integrity and coding to provide strategic leadership for the Physician Organization's Revenue Integrity and Professional Coding Programs, ensuring compliant revenue capture, coding accuracy, and documentation integrity.

The role leads cross-functional governance, partners with Finance and payer relations, and directs performance metrics, audits, and staff development to optimize reimbursement.

Qualifications

• 10+ years in healthcare revenue cycle or related field.
• 5+ years in management or leadership.
• Experience in a physician organization or academic medical center is preferred.

Responsibilities

• Develop and lead the overall strategy for Revenue Integrity and Professional Coding.
• Establish standards, governance, policies, and accountability for coding, charge capture, documentation, and revenue integrity.
• Lead cross-functional committees and workgroups focused on coding, compliance, reimbursement, and revenue optimization.
• Advise senior leadership on regulatory changes, reimbursement issues, coding initiatives, and revenue opportunities.
• Oversee charge capture, charge reconciliation, denial prevention, documentation integrity, and revenue preservation.
• Monitor revenue integrity performance, including denials, underpayments, revenue leakage, reimbursement outcomes, and coding quality.
• Provide strategic oversight of professional coding operations and coding governance.
• Partner with coding leadership on quality improvement, workflow optimization, consistency, and staff development.
• Review audit findings and ensure appropriate corrective actions and remediation.
• Partner with Finance, Contracting, Revenue Cycle, and operational leaders on reimbursement and payer-related issues.
• Develop performance metrics, dashboards, and executive reporting.
• Lead and develop managers overseeing Revenue Integrity and Professional Coding.
• Support workforce planning, succession planning, and leadership development.
• Promote accountability, collaboration, compliance, continuous improvement, and operational excellence.

Skills

Revenue integrity leadership

Coding governance

Strategic planning

Stakeholder management

Regulatory compliance

Healthcare billing knowledge

Education

Bachelor's degree in Finance/Business/Healthcare

Master's degree preferred

Job description

Position summary

The Director of physician revenue integrity and coding provides strategic leadership and oversight for the Physician Organization's Revenue Integrity and Professional Coding Programs. Focuses on compliant revenue capture, coding accuracy, documentation integrity, reimbursement optimization, and regulatory compliance.

Key responsibilities

• Develop and lead the overall strategy for Revenue Integrity and Professional Coding.
• Establish standards, governance, policies, and accountability for coding, charge capture, documentation, and revenue integrity.
• Lead cross-functional committees and workgroups focused on coding, compliance, reimbursement, and revenue optimization.
• Advise senior leadership on regulatory changes, reimbursement issues, coding initiatives, and revenue opportunities.
• Oversee charge capture, charge reconciliation, denial prevention, documentation integrity, and revenue preservation.
• Monitor revenue integrity performance, including denials, underpayments, revenue leakage, reimbursement outcomes, and coding quality.
• Provide strategic oversight of professional coding operations and coding governance.
• Partner with coding leadership on quality improvement, workflow optimization, consistency, and staff development.
• Review audit findings and ensure appropriate corrective actions and remediation.
• Partner with Finance, Contracting, Revenue Cycle, and operational leaders on reimbursement and payer-related issues.
• Develop performance metrics, dashboards, and executive reporting.
• Lead and develop managers overseeing Revenue Integrity and Professional Coding.
• Support workforce planning, succession planning, and leadership development.
• Promote accountability, collaboration, compliance, continuous improvement, and operational excellence.

Minimum qualifications

Education:

• Bachelor's degree required.
• Master's degree preferred.
• Preferred areas: Finance, Business, Coding, or a related clinical discipline.

Experience:

• 10+ years of progressively responsible experience in healthcare revenue cycle, revenue integrity, coding, compliance, audit, or reimbursement.
• 5+ years of management or leadership experience.
• Experience in a physician organization, academic medical center, faculty practice plan, children's hospital, or integrated healthcare system.
• Strong knowledge of healthcare billing, professional coding, ICD-10, CPT, HCPCS, payer policies, and revenue cycle financial metrics.
• Strong strategic thinking, problem-solving, communication, organization, and stakeholder management skills.

Certification:

• No certification required.
• Preferred: CPC, COC, CCS, and/or PMP.

License:

• No license required.
• Clinical license such as RN, RT, MT, or RPh preferred.

Schedule:

M-F 8-5 remote

The posted pay range is Boston Children's reasonable and good-faith expectation for this pay at the time of posting.

Any base pay offer provided depends on skills, experience, education, certifications, and a variety of other job-related factors. Base pay is one part of a comprehensive benefits package that includes flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.