Healthcare Revenue Integrity Manager

Position Summary

This is a senior-level individual contributor role with no direct reports. The Healthcare Revenue Integrity Manager serves as a subject matter expert and strategic partner responsible for identifying opportunities to improve payment accuracy, optimize revenue performance, reduce financial leakage, and enhance operational effectiveness.

This position collaborates across multiple business functions to analyze data, uncover trends, evaluate processes, and develop actionable recommendations that drive measurable business outcomes. The ideal candidate brings a blend of analytical expertise, operational insight, and healthcare industry knowledge, along with the ability to influence stakeholders and lead initiatives without direct authority.

Key Responsibilities

• Analyze payment, reimbursement, operational, and financial performance data to identify trends, risks, and revenue optimization opportunities.
• Investigate payment discrepancies, revenue leakage, process inefficiencies, and performance gaps to determine root causes and potential solutions.
• Develop and present strategic recommendations that improve payment accuracy, reimbursement outcomes, operational efficiency, and overall financial performance.
• Serve as a trusted advisor and subject matter expert to business leaders and cross-functional teams.
• Partner with stakeholders across operations, finance, analytics, compliance, customer-facing teams, and other business functions to support strategic initiatives.
• Monitor key performance indicators (KPIs) and create reporting, dashboards, and business insights to support decision-making.
• Identify opportunities to streamline processes, improve workflows, and enhance operational effectiveness.
• Support projects focused on payment integrity, revenue cycle optimization, reimbursement improvement, and performance management.
• Translate complex data and findings into clear, actionable recommendations for both technical and non-technical audiences.
• Stay informed on industry trends, regulatory changes, reimbursement methodologies, and best practices impacting payment integrity and revenue performance.

Qualifications

• Bachelor's degree or equivalent combination of education and professional experience.
• Five or more years of experience in one or more of the following areas:
  • Payment Integrity
  • Revenue Integrity
  • Revenue Cycle Management
  • Healthcare Operations
  • Reimbursement Analysis
  • Business Analytics
  • Process Improvement
  • Operational Excellence
  • Healthcare Finance
  • Performance Improvement
• Strong analytical, critical thinking, and problem-solving skills.
• Experience analyzing large data sets and leveraging insights to drive business decisions.
• Ability to influence stakeholders and drive initiatives in a highly collaborative environment.
• Excellent communication, presentation, and relationship-building skills.
• Proficiency with Excel and experience using reporting, analytics, or business intelligence tools.

Preferred Qualifications

• Experience within a healthcare, healthcare services, payer, provider, or revenue cycle environment.
• Knowledge of reimbursement methodologies, payment processes, claims analysis, or revenue optimization strategies.
• Experience supporting cross-functional business initiatives and strategic projects.
• Exposure to Lean, Six Sigma, continuous improvement, or operational excellence methodologies.
• Experience creating executive-level reporting, dashboards, and performance metrics.

Success in This Role

Successful candidates will be strategic thinkers who enjoy solving complex business problems, identifying opportunities for improvement, and influencing positive change. They are comfortable working independently, partnering with leaders across multiple functions, and using data-driven insights to improve operational and financial outcomes.

This role is ideal for professionals with backgrounds in payment integrity, revenue cycle, healthcare operations, reimbursement, business analytics, process improvement, or operational excellence who are seeking a highly visible individual contributor position with significant organizational impact.