Director, Revenue Integrity & Coding (Remote)

Boston Children’s Hospital; Westwood, Northern (MA, KY); Hybrid; USD 180,000 - 280,000; Full time

Job summary

Boston Children’s Hospital is seeking a Director of Physician Revenue Integrity to lead and optimize the organization’s revenue integrity and professional coding programs. You will drive compliant revenue capture, ensure documentation integrity, and advise senior leadership on regulatory and reimbursement opportunities.

The role requires a track record of strategic leadership in healthcare revenue cycle, strong coding knowledge, and 10+ years of experience with 5+ years in management.

Qualifications

• Bachelor’s degree required.
• Master’s degree preferred.
• Preferred: CPC, COC, CCS, and/or PMP.
• 10+ years in healthcare revenue cycle, revenue integrity, coding, compliance, audit, or reimbursement.
• 5+ years of management or leadership experience.

Responsibilities

• Develop and lead strategy for Revenue Integrity and Professional Coding.
• Establish governance for coding, charge capture, documentation, and revenue integrity.
• Lead cross-functional committees on coding, compliance, reimbursement, and revenue optimization.
• Advise senior leadership on regulatory changes, reimbursement issues, coding initiatives, and revenue opportunities.
• Oversee charge capture, denial prevention, documentation integrity, and revenue preservation.
• Monitor revenue integrity performance and coding quality; identify risks and opportunities.
• Partner with Finance, Contracting, Revenue Cycle, and operational leaders on payer-related issues.
• Develop performance metrics, dashboards, and executive reporting.

Skills

Strategic leadership

Regulatory compliance

Stakeholder management

Healthcare revenue cycle

Coding knowledge (ICD-10, CPT, HCPCS)

Education

Bachelor’s degree

Master’s degree

Finance/Business/Coding 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