Director - Revenue Integrity

If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered. Day - 08 Hour (United States of America)This is a Stanford Health Care job. A Brief Overview The Director of Revenue Integrity delivers enterprise strategic and operational leadership to drive accurate, compliant, and optimized revenue capture across inpatient, outpatient, professional (faculty practice) and research-related services. This role is accountable for preventing revenue leakage and compliance risk through standardized charge capture, pricing governance, CDM management, revenue reconciliation, and analytics. The Director serves as the liaison between Revenue Cycle, clinical departments, and the School of Medicine. The Director partners closely with clinical departments, School of Medicine leaders and physicians, Advanced Practice Providers (APPs), Coding, Office of Compliance and Privacy, Patient Financial Services, Professional Billing, Finance, Managed Care Contracting, and Technology and Digital Solutions (TDS) to ensures that charging and billing processes are transparent, auditable, and aligned with organizational financial and regulatory objectives. This includes partnership with TDS and Epic application teams to optimize system design, automation, testing, and validation of charge capture and billing workflows to ensure accuracy, efficiency, and safeguarding of revenue. LocationsStanford Health CareWhat you will doLead enterprise Charge Description Master (CDM) Governance, maintenance, and continuous improvement, ensuring accuracy, clarity and regulatory compliance.Establishes revenue cycle reporting requirements to meet the needs and expectations of all constituencies (Director, Finance & Administration -DFAs; Faculty, Director of School Medicine Finance Support) and ensures timely reporting of revenue cycle performance through collaboration with appropriate information sourcesMaintains the Hospital’s charge description master (CDM) by incorporating new charges/services identified by the Revenue Integrity Program Managers, as well as the revenue generating departments, third party changes, CMS special requirement and coding updates. Directs and approves all changes made to the hospital’s charge description master and professional fee schedule, consistent with third party requirements.Assists in the resolution of problems causing payer denial or failed Medicare edits as they involve the charge master and the professional billing office.Works collaboratively with the revenue producing department staff, physicians and school of medicine (SOM) to ensure all charges are captured and documented.Fosters partnering relationships with the Office of Compliance and Privacy, Patient Financial Services, Professional Billing Office, Coding, and other third parties to ensure the accuracy of the CDM, fee schedules and research CDM.Oversees efforts to ensure timely response and compliance with regulatory agencies.Educates hospital departments and physicians with respect to the use and maintenance of the charge master and charging philosophy.Ensures timely review of regulatory literature such as Medicare Newsletter, Program Transmittals and CPT and HCPCS guidelines and implements necessary changes affecting Stanford Hospital and Clinic’s CDM and charge capture systems.Coordinates with Patient Financial Services, Professional Billing Office, and Coding to ensure that the codes contained in the CDM and professional fee schedule are accurate and in compliance with regulatory and/or contractual guidelines and that claims logic is appropriate for accurate billing.Ensures the on-going accuracy and integrity of the CDM and professional fee schedule by ensuring that all charges are communicated and coordinated with the performing departments and physicians to implement necessary changes to charge documents, charge capture process, and order entry procedures.Identifies services that are reimbursable but are not being charged; reviews, assigns, and validates CPT, HCPCS and revenue codes and sets rate. Determines charge and charge attributes for new services and products and responsible for developing and maintaining a rate setting policy.Assists in the resolution of problems causing payer denial or failed Medicare edits as they involve the charge master and professional fee schedule. Works collaboratively with the revenue producing department staff and physicians to ensure all charges are being captured and documented.Facilitates positive communication and build strong relationships between Professional Revenue Cycle Management Operations and clinical chairs (School of Medicine), administrators, other clinic and departmental staff and payors regarding revenue cycle matters.Establishes revenue cycle reporting requirements to meet the needs and expectations of all constituencies (Director, Finance & Administration -DFAs; Faculty, Direct