Revenue Integrity Manager

Revenue Integrity Manager Corona, CA Job Details Full-time $106,640 - $152,880 a year 1 day ago Benefits Paid holidays Health insurance Dental insurance Paid time off Vision insurance Retirement plan Qualifications Collaborate with healthcare professionals Business financial process improvement Financial forecasting Revenue cycle management Accounts receivable Financial close processing Internal controls Machine learning/AI-based analysis Management CPA Medicare Variance analysis 5 years Financial reporting Bachelor's degree in finance Healthcare Administration Bachelor's degree in business Valuation Compliance audits & assessments Data reporting Corrective and preventive actions (CAPA) Finance Master's degree Certified Professional Coder Key Performance Indicators

ICD-10 EMR/EHR HCPCS

Analysis skills Bachelor's degree Financial control management Certified Coding Specialist Mentoring Data analytics Bachelor's degree in healthcare administration Healthcare financial management Financial regulatory compliance Hospital compliance Root cause analysis Bachelor's degree in accounting Benchmarking Senior level AI Business Month-end close Hospital regulatory compliance Medical claim denial management Accounting Hospital experience Cross-functional communication Internal audits Hospital process improvement

DRG Full Job Description Department:

Revenue Cycle /

Finance Reports To:

CFO Location:

Corona, CA Employment Type:

Full-Time

POSITION SUMMARY

The Revenue Integrity Manager is responsible for overseeing revenue validation and financial integrity processes to ensure accurate net patient revenue, regulatory compliance, and optimal reimbursement performance. This role safeguards hospital revenue by analyzing financial, billing, and operational data to identify revenue gaps, contractual variances, and underpayment trends. The Manager conducts detailed Accounts Receivable (AR) valuations and evaluates net realizable value (NRV) to support accurate reporting and forecasting. Through proactive monitoring of key revenue cycle metrics, including denial rates, AR aging, and net collection rates. This position drives continuous improvement initiatives that enhance financial performance. In collaboration with Finance, Health Information Management (HIM), clinical departments, and IT, the Revenue Integrity Manager strengthens charge capture accuracy, optimizes reimbursement outcomes, and implements corrective strategies to prevent revenue leakage while ensuring regulatory compliance.

KEY RESPONSIBILITIES

Revenue Integrity & Financial Oversight Oversee revenue validation and financial integrity processes across the hospital. Analyze financial, billing, and operational data to identify revenue gaps, contractual variances, and underpayment trends. Develop, recommend, maintain and drive KPI benchmarks and indicators for continuous performance improvement. Conduct detailed AR valuations and assess net realizable value (NRV) to ensure accurate revenue recognition. Support month-end close, revenue reporting, and financial forecasting processes. Charge Description Master (CDM) Management Oversee maintenance, validation, and optimization of the Charge Description Master (CDM). Ensure accurate CPT, HCPCS, modifiers, revenue codes, and pricing updates. Coordinate routine CDM reviews to maintain regulatory and payer compliance. Collaborate with clinical departments to ensure accurate charge capture workflows. Revenue Cycle Performance & Denials Management Monitor key performance indicators including denial rates, AR aging, net collection rates, and charge lag. Perform root cause analysis of denials and underpayments. Develop and implement corrective action plans to reduce preventable denials and improve reimbursement. Identify trends impacting financial performance and implement process improvements. Compliance & Regulatory Oversight Ensure compliance with Medicare, Medicaid, and commercial payer regulations. Support internal and external audits. Maintain knowledge of reimbursement methodologies (DRG, APC, etc.). Establish internal controls to safeguard revenue and mitigate financial risk. Cross-Functional Collaboration & Leadership Review, assess and establish machine learning and AI as an operational must have in developing state of the art systems, model development and performing root cause analysis. Partner with Finance, HIM, Patient Finance, and clinical leadership to strengthen revenue capture. Provide education and guidance on revenue integrity best practices. Assist with system upgrades, revenue cycle implementations, and workflow optimization. Lead or mentor revenue integrity analysts, as applicable.

REQUIRED QUALIFICATIONS

Bachelor's degree in healthcare administration, Finance, Accounting, Business, or related field (Master's preferred). Minimum 5 years of progressive hospital revenue cycle experience. Strong knowledge of CDM maintenance, AR valuations, NRV, reimbursement methodologies, and payer regulations. Experience with hospital billing systems and EHR platforms. Knowledge of CPT, ICD-10, and HCPCS coding structures. Strong analytical and problem-solving skills.

PREFERRED QUALIFICATIONS HFMA

(CRCR, CHFP), CCS, CPC, or CPA certification preferred. Experience in multi-facility health systems. Experience with revenue cycle analytics and reporting dashboards.

BENEFITS

Competitive salary Health, dental, and vision insurance Retirement savings plan with employer match Paid time off and holidays Professional development support Employee wellness programs