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Dir,Revenue Integrity-APS

Company: NorthEast Provider Solutions Inc.

City/State: Valhalla, NY

Category: Executive/Management

Department: Revenue Integrity

Union: No

Position: Full Time

Hours: 8:30-5:00pm, M-F

Shift: Day

Req #: 45790

Posted Date: Jan 08, 2026

Hiring Range: $132,242 - $167,395

External Applicant link (https://pm.healthcaresource.com/cs/wmc1/#/preApply/31476) Internal Applicant link

Job Details:

Job Summary:

Responsible for operations and success of Revenue Integrity function in the WMC Health System. Provides oversight to the processes across multiple departments of various activities for the goal of accurate charging and billing.

Responsibilities:

+ Revenue Integrity

+ Overall responsibility for maintaining the Charge Description Master to promote revenue optimization, regulatory compliance, local system standardization, and consistency with local policies.

+ Review all changes made to the CDM.

+ Manages special projects relative to the charge master. Monitors and reports on implementation of recommended improvements. Initiates and participates in focused reviews of pricing, coding, departmental charge structure, and CDM standardization.

+ Works with senior leadership to formulate pricing strategies and mark-up formulas. Coordinates with Manager, Budget, and Financial Planning and Budget Analysts to ensure appropriate CDM pricing. Participates in analyses of price relative to costs and payor reimbursement.

+ -Works with coding personnel and clinical managers to ensure codes in the CDM are current and accurate.

+ Promotes system-wide standardization and identification of best practices.

+ Manages the audit function and related revenue cycle audit processes to promote efficiency and revenue optimization.

+ Performs risk assessment to identify areas of greatest opportunity for process improvement, enhanced charge capture, billing, coding, and reimbursement.

+ Supervises focused audits of revenue cycle processes.

+ Communicates audit results including opportunities for process improvement, revenue realization.

+ Leads or participates in multi-disciplinary teams to enhance revenue cycle processes.

+ Coordinates external reviews.

+ Coordinates with consultant, reviews findings, monitors and reports on implementation of recommendations.

+ Recommends and coordinates use of consultants for specialized activities related to coding, billing and reimbursements.

+ Reviews contracts and other information from 3rd party payors to identify technical billing requirements.

+ Keeps abreast of regulatory changes. Develops and leads departmental process to review new regulatory developments, evaluate impact on CDM and revenue cycle processes, and communicate to other affected departments.

+ Leads implementation of required regulatory changes and ongoing monitoring of success (e.g. APC’s and other new prospective payment systems), including changes to CDM and revenue cycle processes.

+ As appropriate, investigates or refers for investigation, potential compliance issues identified during routine reviews.

+ Conducts and/or supervises routine and special compliance audits as directed by Senior Management, and/or Corporate Compliance Officer.

+ Developing methods to effectively communicate information through presentations, reports, educational programs, memoranda, etc.

+ Providing formal and informal education to leaders and staff in other disciplines on revenue-cycle topics.

+ Knowledge and experience with Electronic Health Record implementation,

+ upgrades and maintenance such as with Cerner, Epic, Meditech etc.

+ Understands the systems and related interfaces, data exchange, flow,

content, testing and troubleshooting and how they are utilized within the context of charge related workflows.

+ Identify opportunities to capture additional revenue with the design build and/or optimization solutions.

+ Assure the CDM build is accurate, up-to-date, reflects current charges.

+ Eliminate possible manual processes, improve efficiency of charge capture.

+ Provide training/education to all clinical areas pertaining to charge posting, reconciliation and corrections.

Qualifications/Requirements:

Experience:

Minimum of 7 years of experience in Healthcare Finance, Billing, and/or Internal Audit functions, required.Prior experience with auditing and internal controls review in a healthcare strongly preferred. General knowledge of healthcare revenue cycle including familiarity with reimbursement methodologies, coding, and CDM, charge capture, and billing processes. Understanding of compliance issues, their importance and consequences. Demonstrated leadership ability including ability to work in a team, build consensus, problem-solve, influence others outside a direct reporting relationship, and handle conflicts with tact. Ability to work effectively and coordinate the activities of outside consultants. Requires strong technical skills including use of e-mail, spreadsheets, word processing, databases, decision support system, EHR applications, internet searches for research, project management, and reporting.

Education:

Associate Degree in Accounting, Finance or related field required.Bachelor’s degree, preferred.

Licenses / Certifications:

N/A

Other:

Works in a normal office environment where this is minimal discomfort due to dust, dirt or excessive noise. Moves to all areas of the department and to all three facilities; must be mobile, have a clean driving license and be able to lift objects consistent with normal office work using lifting techniques demonstrated/discussed in orientation.

About Us:

NorthEast Provider Solutions Inc.

Benefits:

We offer a comprehensive compensation and benefits package that includes:

+ Health Insurance

+ Dental

+ Vision

+ Retirement Savings Plan

+ Flexible Savings Account

+ Paid Time Off

+ Holidays

+ Tuition Reimbursement

External Applicant link (https://pm.healthcaresource.com/cs/wmc1/#/preApply/31476) Internal Applicant link

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