Executive Director, Revenue Integrity Operations

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

Job Description:

Oversight of Strategic Pricing Function: - Partner with the Strategic Pricing team to align charge structure, pricing methodologies, and CDM governance across the enterprise. - Ensure pricing changes are operationally executable, properly built into Epic systems, and reconciled through charge capture workflows. - Serve as an operational counterpart to Pricing leadership, ensuring downstream charge behavior, edits, and reimbursement impacts are monitored and addressed.

Essential Duties & Responsibilities including but not limited to:

• Direct and independently manage the triage, routing, and resolution of enterprise revenue integrity issues including charging defects, workflow failures, systemic edit patterns, and payer requirement changes.
• Maintain ownership of issue escalation pathways and ensure timely closure with cross-functional coordination.
• Define, monitor, and manage service levels (SLAs) for charge posting timeliness, edit resolution, CDM turnaround, audit response, and charge reconciliation.
• Lead systemwide adoption of standardized charge capture workflows, reconciliation processes, and CDM governance practices.
• Provide operational direction to revenue integrity staff and partner teams across BILH to ensure consistent application of enterprise standards.
• Lead cross-functional workgroups to address charging issues, regulatory changes, Epic build impacts, and payer-driven charging requirements.
• Oversee day-to-day charge review, edit work queue management, prioritization, quality controls, and escalation pathways.
• Drive financial performance by ensuring accurate gross revenue capture and supporting net revenue optimization.
• Produce executive-ready reporting and analytics on charge capture, edit trends, and CDM performance.

Minimum Qualifications:

• Education: Bachelor’s degree required; Master’s degree preferred.
• Experience: Minimum of 10 years’ progressive experience in revenue integrity, charge capture, CDM governance, or revenue cycle operations, including multi-facility or systemwide leadership experience; strong leadership skills.
• Experience: Experience with Epic charge router logic, workflow optimization, and reporting tools.

Skills, Knowledge & Abilities:

• Deep expertise: in end-to-end charge capture workflows (hospital and professional billing).
• Strong command: of edit logic, payer rules, and regulatory compliance.
• Advanced understanding: of CDM structure, governance models, and pricing methodology.
• Influence: leaders across clinical, financial, and operational domains.
• Prioritize and manage: multiple complex issues in a high-volume environment.
• Independently manage: complex issues and direct cross-organizational resolution efforts.

Preferred Qualifications & Skills:

• Revenue Cycle or Analytics certifications: preferred.

Key Business Relationships (Title and Purpose):

• Hospital CFOs & Executive Directors: Ensure effective implementation of enterprise RI standards.
• Clinical Revenue Cycle Lead: Align on enterprise RI priorities and system performance.
• Revenue Cycle Business Partners: Communicate charge performance trends and triage barriers.
• Strategic Pricing & BILPN: Coordinate pricing structure and CDM changes with BILPN Contracting function
• IT / Epic Application Teams: Drive build governance, testing, and operational readiness.
• Compliance & Internal Audit: Ensure regulatory adherence and audit readiness.

Physical Requirements & Environment:

• Standard office environment; extensive computer use; ability to travel between sites as needed.

Pay Range:

$180,000.00 USD – $210,000.00 USD