Senior Enterprise Revenue Integrity & Strategic SME

Altivera Medical; Denver (CO); On-site; USD 120,000 - 160,000; Full time

Job summary

Altivera Medical seeks a seasoned professional to proactively identify, monitor, and mitigate enterprise revenue risks. You will partner with Revenue Systems Strategy & Business Optimization, Billing Operations, Revenue Recovery, Financial Reconciliation, Payer Relations, and executive leadership to address revenue leakage and improve reimbursement outcomes.

The role requires deep knowledge of revenue cycle operations, reimbursement methodologies, and strong analytical and leadership

Qualifications

• Experience in revenue integrity and payment integrity initiatives.
• Ability to analyze operational, financial, and system-related issues to identify risks and opportunities.

Responsibilities

• Serve as the organization's subject matter expert for revenue integrity and payment integrity initiatives.
• Develop and maintain enterprise revenue integrity monitoring programs.
• Identify risks impacting reimbursement accuracy and financial performance.
• Evaluate operational controls designed to prevent revenue leakage.
• Support governance standards, policies, and best practices.
• Identify trends contributing to revenue leakage across the revenue cycle.
• Monitor reimbursement accuracy and financial performance indicators.
• Evaluate denied claims, underpayments, write-offs, adjustments, and operational exceptions for emerging risks.
• Quantify financial impact and recommend corrective actions.
• Escalate significant revenue risks to leadership.

Job description

Description

This role proactively identifies, monitors, and mitigates enterprise revenue risks. It partners with Revenue Systems Strategy & Business Optimization, Billing Operations, Revenue Recovery, Financial Reconciliation, Payer Relations, and executive leadership to address revenue leakage, audit processes, validate payer and contract compliance, evaluate system performance, and improve reimbursement outcomes.

• Revenue Integrity Expertise: Comprehensive understanding of revenue cycle operations, reimbursement methodologies, payment integrity, billing compliance, denial prevention, charge accuracy, and revenue leakage prevention.
• Strategic Analysis & Problem Solving: Ability to analyze complex operational, financial, reimbursement, and system-related issues to identify root causes, risks, and opportunities for improvement.
• Business Intelligence & Analytics: Advanced analytical capabilities with experience interpreting trends, performance metrics, operational data, and financial outcomes to support decision-making.
• Enterprise Governance & Controls: Knowledge of internal controls, auditing methodologies, compliance monitoring, process validation, and operational risk management.
• Revenue Performance Management: Ability to evaluate reimbursement trends, operational performance, payer outcomes, contract compliance, and revenue cycle effectiveness.
• Cross-Functional Leadership: Strong ability to influence stakeholders, facilitate collaboration, drive accountability, and lead initiatives without direct authority.
• Communication & Executive Presence: Ability to communicate findings, recommendations, risks, and strategic opportunities effectively to operational leaders and executive stakeholders.

Essential Duties & Responsibilities

Enterprise Revenue Integrity Governance

• Serve as the organization's subject matter expert for revenue integrity and payment integrity initiatives.
• Develop and maintain enterprise revenue integrity monitoring programs.
• Identify risks impacting reimbursement accuracy, financial performance, and revenue recovery.
• Evaluate operational controls designed to prevent revenue leakage.
• Support the development of governance standards, policies, and best practices.
• Identify trends contributing to revenue leakage across the revenue cycle.
• Monitor reimbursement accuracy and financial performance indicators.
• Evaluate denied claims, underpayments, write-offs, adjustments, and operational exceptions for emerging risks.
• Quantify financial impact and recommend corrective actions.
• Escalate significant revenue risks to leadership.

Job Details