Director System Revenue Integrity

Socket.dev; Hyannis (MA); On-site; USD 110,000 - 140,000; Full time

Job summary

Socket.dev is seeking a senior Revenue Integrity leader to establish KPIs, implement action plans, and oversee a system-wide charge review program. You will drive policy development, SLA alignment, and cross-functional collaboration to minimize revenue leakage and ensure compliance.

The role requires strong analytics, leadership, and healthcare finance expertise to deliver measurable improvements across the revenue cycle and related support departments.

Qualifications

• Bachelor's degree in Business Administration, Healthcare Management or related discipline.
• 5–7 years of experience in a complex healthcare organization.
• 3–5 years of supervisory/management experience.
• Strong working knowledge of billing and collection processes and revenue cycle management.
• Analytical and data synthesis skills with ability to identify trends and opportunities.

Responsibilities

• Lead KPI establishment and annual reviews; implement performance action plans.
• Develop and oversee operational policies, processes, tools, and educational materials.
• Oversee Charge Review program to minimize revenue leakage through audits and proactive reviews.
• Ensure CDM compliance with regulatory and payer requirements and establish charging methods.
• Monitor SLAs and collaborate with Revenue Cycle, Clinical operations, HR, IT, and Finance.
• Identify process improvements in charge capture and audit workflows; drive design and implementation.
• Develop reporting for audit outcomes and revenue integrity metrics.
• Lead performance reviews and reward effective performance; foster continuous improvement.

Skills

KPI development

Stakeholder communication

Data analytics

Process improvement

Leadership

Revenue cycle knowledge

Policy development

Education

Bachelor's degree in Business Administration, Healthcare Management or related discipline

Tools

Billing systems

Healthcare analytics tools

Job description

1. Lead the establishment and implementation of Key Performance Indicators (“KPIs”) for revenue integrity functions;
   ensure the implementation of action plans where performance is not meeting expectations; review KPI expectations
   annually and adjust appropriately; recognize areas of excellence.
2. Develop, implement, and oversee effective and consistent operational policies, processes, tools, and educational
   materials within all Revenue Integrity functional areas.
3. Oversee the operational performance of a system-wide, service line-based Charge Review program dedicated to
   identifying charge capture issues/improvement opportunities to minimize revenue leakage, through the use of technology
   enablers and proactive internal audits/reviews of charging practices.
4. Ensure that the CDM is compliant with regulatory and payer requirements and that all services provided have an
   established charging and reconciliation methodology.
5. Ensure Revenue Integrity employees across all functions comply with established policies, processes, and quality
   assurance programs.
6. Identify potential process improvements in charge capture functions, and lead the design and implementation as
   required.
7. Monitor and facilitate service level agreements (“SLAs”) between Revenue Integrity operations and other related
   functions within both Revenue Cycle and Clinical operations. This includes confirmation that charge review queues/
   requests are managed appropriately.
8. Build strong relationships and facilitate productive communication between key Revenue Cycle stakeholders, including
   peer leaders of Revenue Cycle services and core support departments (e.g., human resources, IT, finance).
9. Develop, implement, and manage efficient and effective operational policies, procedures, processes and performance
   monitoring across all revenue integrity functions.
10. Ensure audit of denial management processes occurs consistently and coordinate with peers across the revenue cycle
    organization, and with other related stakeholders, to identify trends and implement denial prevention/recovery programs.
11. Oversee, measure, and report ongoing financial and operational performance of Revenue Integrity, audit and appeals
    outcomes and denial management across CCHC.
12. Support CCHC strategic initiatives that require involvement from revenue integrity functions as required.
13. Assess direct reports’ performance on a consistent basis and provide feedback to reward effective performance and
    enable proactive performance improvement steps to be taken.
14. Lead the establishment and implementation of Key Performance Indicators (“KPIs") for audit and appeal functions;
    ensure the implementation of action plans where performance is not meeting expectations; review KPI expectations
    annually and adjust appropriately; recognize areas of excellence.
15. Develop reporting to support the transparency of audit and appeals outcomes
16. Identify potential process improvements within the audit and appeals workflows and lead the design and
    implementation as required.
17. Develop and monitor productivity metrics for all Revenue Integrity functional areas
18. Oversees payment variance team members and workflows
19. Seeks opportunities to address and remedy system and/or payer related issues causing payment variances
20. Develop reporting to identify and monitor root cause payment variance issues
21. Reports payment variances to executive leadership
22. Challenges current working practices; identifies process improvement opportunities and presents recommendations
    and solutions to management. Engages and commits to the organization’s culture of continuous improvement by
    actively participating, supporting, and promoting CCHC Pillars of Excellence.

• Bachelor's degree in Business Administration, Healthcare Management or related discipline and or equivalent
  experience.
• Minimum of five to seven years of relevant experience with a track record of progressively responsible positions in a
  complex healthcare organization such as a multi-hospital system, large group practice or a major healthcare consulting
  firm preferred.
• Minimum of three to five years of supervisory/management experience.
• Strong working knowledge of billing and collection processes and functions, charging processes and general revenue
  cycle management strategies, and industry best practices.
• Thorough knowledge of metrics, analytics, and data synthesis in healthcare revenue integrity and revenue cycle
  management to identify trends, produce reliable forecasts and projections.
• Strong analytical and critical-thinking, organizational, and business process optimization skills, with in-depth ability to
  develop and pursue goals, synthesize data to identify system vulnerabilities and develop and apply innovative solutions.
• Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the
  general public.
• An understanding of the psychology of complex corporate relationships, and an ability to influence within such an
  environment.
• Excellent communication, leadership, delegation, and interpersonal skills.
• Above average understanding of how, when, and to what extent different hospital departments relate to and
  communicate with one another.