Director, Revenue Integrity & Professional Billing Clinical Documentation Integr
Medical College of Wisconsin, New York, New York, United States
Summary
The Director of Revenue Integrity & Professional Billing CDI is a strategic leader responsible for optimizing clinical documentation, professional billing accuracy, and revenue cycle performance. This role oversees CDI efforts to assure Denials Prevention, Clinical Documentation Improvement, Provider Education, and Professional Services Auditing. The Director will lead initiatives to reduce denials, enhance charge capture, and ensure compliance with payer and regulatory requirements. This position requires strong leadership, analytical acumen, and the ability to collaborate across departments to drive documentation excellence and revenue integrity.
Primary Responsibilities
Leadership & Team Oversight Lead and mentor teams including RNs, coders, documentation specialists, and managers across Denials Prevention, CDI, Provider Education, and Auditing.
Foster a culture of accountability, collaboration, and continuous improvement.
Conduct performance evaluations and support professional development.
Program & Operational Management
Oversee daily operations of CDI program.
Ensure alignment with organizational goals, compliance standards, and payer requirements.
Develop and implement strategies, policies, and procedures to improve revenue cycle performance.
Documentation Optimization & Provider Education
Optimize Epic clinical documentation templates and functionality for accurate charge capture.
Develop specialty-specific education programs to improve documentation, coding and billing accuracy.
Ensure adherence to industry regulations, coding guidelines, and reimbursement methodologies.
Serve as a subject matter expert related to clinical documentation and provide education and training as needed.
Analytics & Strategic Initiatives
Utilize data analytics to identify trends, monitor KPIs, and drive performance improvements.
Develop dashboards and reports to communicate program impact and opportunities.
Lead cross-functional meetings and present outcomes to senior leadership.
Stakeholder Engagement
Collaborate with compliance, coding, clinical, and revenue cycle leadership.
Serve as liaison between providers, coders, and operational teams.
Knowledge - Skills - Abilities
Strong leadership and persuasive communication skills.
Proficiency in clinical and financial data analysis.
Expertise in Epic documentation, coding, and charge capture workflows.
Advanced skills in Excel, Tableau, Power BI, or similar tools.
Deep understanding of CPT, ICD-10, professional claims processing, and payer behavior.
Ability to manage multiple priorities in a fast-paced environment.
Qualifications
Appropriate experience may be substituted for education on an equivalent basis.
Minimum Required Education:
Bachelor's degree in Nursing, Health Information Management, Healthcare Administration, Program Management or related field.
Minimum Required Experience:
Five (5) years of leadership experience in revenue cycle operations, clinical documentation, coding, healthcare administration, program management or related field.
Preferred Education:
Master's degree in Business Administration, Healthcare Administration, Nursing, or related discipline.
Preferred Experience:
Progressive responsibility in healthcare administration.
Preferred Certification / Licensure(s):
CPC, CPC-A, CCS-P, CCA, RHIT, RHIA, CDIP, CCDS, or CPMA. Nursing degree (RN) strongly encouraged.
Physical Requirements
Work requires occasionally lifting moderate weight materials, standing, or walking continuously.
Work Environment
Occasional exposure to dust, noise, temperature changes, or contact with water or other liquids. Work is performed in an environmentally controlled environment.
Sensory Acuity
Ability to detect and translate speech or other communication required. May occasionally require the ability to distinguish colors and perceive relative distances between objects.
#LI-RT1
Why MCW?
Outstanding Healthcare Coverage, including but not limited to Health, Vision, and Dental. Along with Flexible Spending options
403B Retirement Package
Competitive Vacation and Paid Holidays offered
Tuition Reimbursement
Paid Parental Leave
Employee & Family Assistance Program (EFAP)
Pet Insurance
On campus Fitness Facility, offering onsite classes
Additional discounted rates on items such as: Select cell phone plans, local fitness facilities, Milwaukee recreation and entertainment etc.
For a brief overview of our benefits see: Benefits Overview
For a full list of positions see: MCW Careers
At MCW all of our endeavors, from our internal operations to our interactions with our partners, are driven by our shared organizational values: Caring - Collaborative - Curiosity - Inclusive - Integrity - Respect. We are committed to fostering an inclusive environment that values diversity in backgrounds, experiences, and perspectives through merit-based processes and in alignment with all applicable laws. We believe that embracing human differences is critical to realize our vision of a healthier world, and we recognize that a healthy and thriving community starts from within. Our values define who we are, what we stand for and how we conduct ourselves at MCW. If you believe in embracing individuality and working together according to these principles to improve health for all, then MCW is the place for you. For more information, please visit our institutional website.
MCW as an Equal Opportunity Employer and Commitment to Non-Discrimination:
The Medical College of Wisconsin (MCW) is an Equal Opportunity Employer. We are committed to fostering an inclusive community of outstanding faculty, staff, and students, as well as ensuring equal educational opportunity, employment, and access to services, programs, and activities, without regard to an individual's race, color, national origin, religion, age, disability, sex, gender identity/expression, sexual orientation, marital status, pregnancy, predisposing genetic characteristic, or military status. Employees, students, applicants or other members of the MCW community (including but not limited to vendors, visitors, and guests) may not be subjected to harassment that is prohibited by law or treated adversely or retaliated against based upon a protected characteristic.
The Director of Revenue Integrity & Professional Billing CDI is a strategic leader responsible for optimizing clinical documentation, professional billing accuracy, and revenue cycle performance. This role oversees CDI efforts to assure Denials Prevention, Clinical Documentation Improvement, Provider Education, and Professional Services Auditing. The Director will lead initiatives to reduce denials, enhance charge capture, and ensure compliance with payer and regulatory requirements. This position requires strong leadership, analytical acumen, and the ability to collaborate across departments to drive documentation excellence and revenue integrity.
Primary Responsibilities
Leadership & Team Oversight Lead and mentor teams including RNs, coders, documentation specialists, and managers across Denials Prevention, CDI, Provider Education, and Auditing.
Foster a culture of accountability, collaboration, and continuous improvement.
Conduct performance evaluations and support professional development.
Program & Operational Management
Oversee daily operations of CDI program.
Ensure alignment with organizational goals, compliance standards, and payer requirements.
Develop and implement strategies, policies, and procedures to improve revenue cycle performance.
Documentation Optimization & Provider Education
Optimize Epic clinical documentation templates and functionality for accurate charge capture.
Develop specialty-specific education programs to improve documentation, coding and billing accuracy.
Ensure adherence to industry regulations, coding guidelines, and reimbursement methodologies.
Serve as a subject matter expert related to clinical documentation and provide education and training as needed.
Analytics & Strategic Initiatives
Utilize data analytics to identify trends, monitor KPIs, and drive performance improvements.
Develop dashboards and reports to communicate program impact and opportunities.
Lead cross-functional meetings and present outcomes to senior leadership.
Stakeholder Engagement
Collaborate with compliance, coding, clinical, and revenue cycle leadership.
Serve as liaison between providers, coders, and operational teams.
Knowledge - Skills - Abilities
Strong leadership and persuasive communication skills.
Proficiency in clinical and financial data analysis.
Expertise in Epic documentation, coding, and charge capture workflows.
Advanced skills in Excel, Tableau, Power BI, or similar tools.
Deep understanding of CPT, ICD-10, professional claims processing, and payer behavior.
Ability to manage multiple priorities in a fast-paced environment.
Qualifications
Appropriate experience may be substituted for education on an equivalent basis.
Minimum Required Education:
Bachelor's degree in Nursing, Health Information Management, Healthcare Administration, Program Management or related field.
Minimum Required Experience:
Five (5) years of leadership experience in revenue cycle operations, clinical documentation, coding, healthcare administration, program management or related field.
Preferred Education:
Master's degree in Business Administration, Healthcare Administration, Nursing, or related discipline.
Preferred Experience:
Progressive responsibility in healthcare administration.
Preferred Certification / Licensure(s):
CPC, CPC-A, CCS-P, CCA, RHIT, RHIA, CDIP, CCDS, or CPMA. Nursing degree (RN) strongly encouraged.
Physical Requirements
Work requires occasionally lifting moderate weight materials, standing, or walking continuously.
Work Environment
Occasional exposure to dust, noise, temperature changes, or contact with water or other liquids. Work is performed in an environmentally controlled environment.
Sensory Acuity
Ability to detect and translate speech or other communication required. May occasionally require the ability to distinguish colors and perceive relative distances between objects.
#LI-RT1
Why MCW?
Outstanding Healthcare Coverage, including but not limited to Health, Vision, and Dental. Along with Flexible Spending options
403B Retirement Package
Competitive Vacation and Paid Holidays offered
Tuition Reimbursement
Paid Parental Leave
Employee & Family Assistance Program (EFAP)
Pet Insurance
On campus Fitness Facility, offering onsite classes
Additional discounted rates on items such as: Select cell phone plans, local fitness facilities, Milwaukee recreation and entertainment etc.
For a brief overview of our benefits see: Benefits Overview
For a full list of positions see: MCW Careers
At MCW all of our endeavors, from our internal operations to our interactions with our partners, are driven by our shared organizational values: Caring - Collaborative - Curiosity - Inclusive - Integrity - Respect. We are committed to fostering an inclusive environment that values diversity in backgrounds, experiences, and perspectives through merit-based processes and in alignment with all applicable laws. We believe that embracing human differences is critical to realize our vision of a healthier world, and we recognize that a healthy and thriving community starts from within. Our values define who we are, what we stand for and how we conduct ourselves at MCW. If you believe in embracing individuality and working together according to these principles to improve health for all, then MCW is the place for you. For more information, please visit our institutional website.
MCW as an Equal Opportunity Employer and Commitment to Non-Discrimination:
The Medical College of Wisconsin (MCW) is an Equal Opportunity Employer. We are committed to fostering an inclusive community of outstanding faculty, staff, and students, as well as ensuring equal educational opportunity, employment, and access to services, programs, and activities, without regard to an individual's race, color, national origin, religion, age, disability, sex, gender identity/expression, sexual orientation, marital status, pregnancy, predisposing genetic characteristic, or military status. Employees, students, applicants or other members of the MCW community (including but not limited to vendors, visitors, and guests) may not be subjected to harassment that is prohibited by law or treated adversely or retaliated against based upon a protected characteristic.