Revenue Integrity Manager

Job Purpose Responsible for managing day-to-day Revenue Integrity operations to ensure accurate charge capture, coding compliance, billing integrity, and reimbursement optimization. The role supports the implementation of revenue integrity initiatives, identifies revenue leakage opportunities, and ensures compliance with organizational policies, payer requirements, and healthcare regulations. The Revenue Integrity Manager collaborates closely with Coding, Billing, Clinical Operations, Finance, and Contracting teams to improve revenue cycle performance and support sustainable revenue outcomes Roles and Responsibilities Organizational Accountabilities - Ensure work is performed based on approved policies, processes, procedures, and instructions. - Identify opportunities for continuous improvement of systems, processes and practices considering leading practices, cost reduction and productivity improvement. - Ensure day-to-day activities are properly performed in line with policies and procedures. - Follow-up on escalated cases/issues of subordinates to ensure they are closed efficiently and in a timely manner. Functional Accountabilities Revenue Integrity Operations - Manage daily Revenue Integrity activities across assigned facilities. - Monitor charge capture processes and identify missed revenue opportunities. - Support implementation of revenue integrity controls and procedures. - Ensure compliance with organizational revenue integrity standards. Coding & Documentation Review - Monitor coding quality and documentation compliance. - Review coding accuracy and reimbursement impact. - Coordinate with CDI and Coding teams to address deficiencies. - Support coding audits and corrective action plans. Billing & Claims Validation - Review billing integrity and claim submission accuracy. - Monitor claim denials and reimbursement trends. - Identify root causes of denials and revenue leakage. - Implement corrective actions to improve first-pass claim acceptance. Revenue Leakage Monitoring - Analyze revenue leakage trends. - Investigate underpayments and missed charges. - Recommend process improvements to minimize financial losses. - Support revenue recovery initiatives. Audit & Compliance - Conduct routine revenue integrity audits. - Support payer audits and compliance reviews. - Ensure compliance with:- CCHI - NPHIES - ICD-10-AM - CPT Team Leadership - Supervise Revenue Integrity Specialists and Analysts. - Conduct performance evaluations. - Support team development and training programs. - Ensure productivity and quality standards are achieved. Key Contacts Key Internal Stakeholders - Chief Commercial Officer - All staff Key External Stakeholders - Insurance Companies and TPAs - Council of Cooperative Health Insurance (CCHI) - NPHIES Platform Representatives - External Auditors and Coding Consultants - Regulatory Authorities (MOH) Requirements: Job Qualifications and Requirements Knowledge and Experience - 8-10 years of experience in revenue cycle management, revenue integrity, coding, or healthcare finance, with at least 5 years in a senior leadership role. - Strong knowledge of Saudi healthcare reimbursement frameworks, including CCHI and NPHIES. - In-depth understanding of clinical documentation, coding standards, and billing regulations. - Proven experience leading revenue integrity programs and audit initiatives. - Strong analytical, leadership, and stakeholder management skills. - Experience working with HIS, billing, and analytics systems. Education and Certifications - Bachelor’s degree in Healthcare Administration, Health Information Management, Finance, or related field (required). - Certified Revenue Cycle Professional (CRCP) or equivalent – highly desirable. - Certified Coding Specialist (CCS) or CPC – advantageous. - Certified Healthcare Financial Professional (CHFP) – preferred. - Training or certification related to CCHI / NPHIES – highly desirable. - Continuous professional development in healthcare revenue integrity and compliance is required. Skills - Proven expertise in healthcare and government sectors, with strategic planning capabilities. - Strong skills in communication, mediation, and conflict resolution. - Deep understanding of data compliance, regulations, and policies. - Excellent administrative and organizational skills. - Good communication skills in Arabic and English (verbal and written). - Strong proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook). - Ability to prepare clear reports, meeting minutes, and maintain accurate records. Attitude - Strong Work Ethic - Dependability and Responsibility - Possessing a Positive Attitude - Adaptability - Honesty and Integrity - Self-Motivated - Motivated to Grow and Learn - Strong Self-Confidence Competencies - Team Leadership - Coaching & Development - Decision Making - Stakeholder Collaboration - Performance Management - Revenue Integrity Operations - Coding Compliance - Charge Capture Management - Revenue Leakage Analysis -

Revenue Integrity Operations: Manage daily Revenue Integrity activities across assigned facilities. Monitor charge capture processes and identify missed revenue opportunities. Support implementation of revenue integrity controls and procedures. Ensure compliance with organizational revenue integrity standards. Coding & Documentation Review: Monitor coding quality and documentation compliance. Review coding accuracy and reimbursement impact. Coordinate with CDI and Coding teams to address deficiencies. Support coding audits and corrective action plans. Billing & Claims Validation: Review billing integrity and claim submission accuracy. Monitor claim denials and reimbursement trends. Identify root causes of denials and revenue leakage. Implement corrective actions to improve first-pass claim acceptance. Revenue Leakage Monitoring: Analyze revenue leakage trends. Investigate underpayments and missed charges. Recommend process improvements to minimize financial losses. Audit & Compliance: Conduct routine revenue integrity audits. Support payer audits and compliance reviews. Ensure compliance with:- CCHI - NPHIES - ICD-10-AM - CPT. Team Leadership: Supervise Revenue Integrity Specialists and Analysts. Conduct performance evaluations. Support team development and training programs. Ensure productivity and quality standards are achieved.