What are the responsibilities and job description for the Director, Revenue Integrity & Professional Billing Clinical Documentation Integrity (CDI) position at Medical College of Wisconsin?
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.