Sr. 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 Senior Director of Revenue Integrity is a strategic, systems-oriented leader responsible for enterprise-wide leadership, strategic direction, and oversight of hospital and professional revenue integrity operations across Stanford Health Care and SHC Tri-Valley. This role ensures full revenue capture, accurate and compliant charging, optimized coding integration, and strong cross functional alignment with clinical, operational, and financial stakeholders. Operating as a key leader within the Mid-Revenue Cycle, the Senior Director partners closely with executive leaders, clinical department chairs, clinical leadership, finance, School of Medicine partners, Supply Chain, Pharmacy, Strategic Pricing and IT teams. The role is accountable for developing and operationalizing strategies that enhance revenue performance, ensure regulatory compliance, charge capture workflows, and enterprise wide process optimization. The position is accountable for developing and operationalizing strategies that enhance revenue performance, ensure regulatory compliance, improve charge capture workflows, and drive enterprise-wide process standardization and optimization. The Senior Director utilizes data driven insights, technology advancements (including AI enabled tools) solutions, and process innovation to advance revenue integrity functions. This individual is responsible for leading multiple functional teams, managing substantial budgets, developing long-range planning, and ensuring that strategic initiatives align with Stanford Health Care priorities for patient care, teaching, research, and financial stewardship. Locations Stanford Health Care What you will do Strategic Leadership & Governance Develops organizational strategies for enterprise-wide hospitals and professional revenue integrity, including long-range plans and annual goals. Leads policy development for charging, charge capture, validation, charge reconciliation, CDM Governance and documentation integrity. Oversees integration of revenue integrity operations across clinical departments, SOM leadership, Patient Financial Services, Office of Compliance & Privacy, HIM, and Coding. Represents Revenue Integrity as a senior leader on enterprise committees, Steering Committees, Quality & Compliance groups, and major IT optimization programs. Serves as a thought leader and change agent, driving innovation, automation, and best practice across the revenue integrity functions. Operational Effectiveness & Workflow Optimization Ensures timely, accurate, and compliant completion of all charge capture, CDM maintenance, reconciliations, and revenue validation activities. Designs and oversees comprehensive quality assurance programs for charging accuracy, documentation integrity, coding quality integration, and loss prevention. Utilizes Lean, Six Sigma, and process improvement methodologies to optimize workflows and eliminate preventable revenue leakage. Ensures the appropriate EPIC system configuration, workflow alignment, and adoption of technology enhancement opportunities. Stakeholder Engagement & Communication Serves as the primary liaison for SHC revenue integrity matters to School of Medicine DFAs, Clinical Department Chairs, clinical leadership, and administrative partners. Directs preparation of enterprise dashboards, KPIs, business reviews, and executive level reporting. Educates hospital and professional revenue generating departments on charge capture requirements, compliance, and CDM practices. Charge Description Master (CDM) & Professional Fee Schedule Oversight Oversees governance of the hospital CDM and SOM professional fee schedule to ensure regulatory compliance and revenue accuracy. Approves additions, deletions, and modifications stemming from new services, regulatory updates, payor requirements, and clinical changes. Ensures alignment between CDM, fee schedules, clinical documentation, and EPIC configuration. Revenue Optimization & Denial Prevention Leads enterprise initiatives to mitigate late charges, preventable denials, claim edit failures, and avoidable under billing. Identifies meaningful revenue opportunities using analytics, benchmarking, and auditing. Technology, EHR, & Emerging Capabilities Partners with IT, EPIC leadership, Revenue Cycle Optimization and digital innovation teams to enhance revenue impacting workflows. Evaluates and integrates AI driven tools for charge capture, audit support, and documentation improvement. Ensures staff have the technology, training, and resources needed for optimized performance. Leadership, Talent Development & Culture Leads and mentors a team that may include directors, managers, supervisors, analysts, CDM experts, revenue integrity specialists, and charge capture teams. Ensures staffing, succession planning, performance management, and professional development at all levels. Fosters a culture of collaboration, accountability, innovation, and high reliability. Education Qualifications Bachelor’s degree from an accredited college or university with a major in business administration, health care administration, or a related field Required Master’s degree in a related field Preferred Experience Qualifications 10+ years of progressive leadership experience in hospital and/or professional revenue integrity, charge capture, CDM governance, HIM, Coding, or Revenue Cycle functions. Experience managing multi department operations, large teams, and enterprise initiatives. Required 5+ years EPIC experience (HB/PB billing, clinical documentation, charge capture technologies). Required Experience working in an academic medical center. Required Member in Healthcare Financial Management Association or the American Academy of Professional Coders or American Health Information Management Association Preferred Required Knowledge, Skills and Abilities Knowledge of all aspects of healthcare revenue cycle functions, including registration, coding and documentation standards, billing and collection processes, as well as government and payer regulations. Expert knowledge of CMS regulations, payer requirement, and healthcare reimbursement methodologies, including the data elements associated with the UB-04 and CMS-1500 claim form. Advance understanding of medical records, hospital and professional billing, charge description master (CDM) structures, and service item master data. Strong understanding of organizational, administrative, fiscal and personnel management principles within complex healthcare environments. Ability to conduct and interpret qualitative and quantitative analysis, financial analysis, healthcare economics and business processes, information systems, organizational development, health care delivery systems, project management or new business development. Strong organizational skills with the ability to prioritize, manage multiple initiatives, adapt to changing priorities, and operate effectively in a fast-paced environment. Ability to provide leadership and influence others. Ability to foster effective working relationships and build consensus. Ability to mediate and resolve complex problems and issues. Ability to develop long-range business plans and strategy. Expert level understanding of CDM structure, CPT/HCPCS/ICD coding frameworks, revenue cycle operations, and reimbursement models. Comprehensive knowledge of Medicare, Medicaid, and commercial payer rules, claim edits, billing compliance, and regulatory requirements at the local, state and federal levels. Proven ability to develop, execute, and sustain and execute organizational strategies across complex health systems. Strong financial acumen with ability to analyze revenue performance trends and operational KPIs and identify revenue integrity opportunities. Exceptional leadership and influencing skills, with the ability to guide teams, influence senior leaders, and build consensus across diverse stakeholder groups. Advanced problem solving skills, including root cause analysis, process redesign, and change management and resolution of complex operational issues. Excellent communication, negotiation, and relationship building abilities, with a demonstrated capacity to foster effective partnerships and collaborative working relationships. Preferred Knowledge, Skills and Abilities Experience leading large scale IT initiatives, EPIC optimization, or digital transformation projects. Licenses and Certifications RHIA - Registered Health Information Administrator required within 1 Year or RHIT - Registered Health Information Technician required within 1 Year or CCS - Certified Coding Specialist required within 1 Year or CPC - Certified Professional Coder required within 1 Year or CCS-P - Certified Coding Specialist – Physician-based required within 1 Year or CPA - Certified Public Accountant required within 1 Year CRCR - Certified Revenue Cycle Representative preferred Certified Healthcare Revenue Integrity - CHRI preferred Epic Resolute Hospital Billing preferred Epic Charge Router preferred These principles apply to ALL employees: SHC Commitment to Providing an Exceptional Patient & Family Experience Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery. You will do this by executing against our three experience pillars, from the patient and family’s perspective: Know Me: Anticipate my needs and status to deliver effective care Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health Coordinate for Me: Own the complexity of my care through coordination Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements. Base Pay Scale: Generally starting at $100.03 - $132.51 per hour The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.