Managing Consultant – Coding, Middle Revenue Cycle, Healthcare

This is a fully remote position, open to applicants in United States.

📋 Description

• Lead and facilitate qualitative and quantitative projects aimed at enhancing coding accuracy, compliance, productivity, timeliness, reimbursement, and financial performance.

• Assist in the expansion of BRG’s middle revenue cycle capabilities, encompassing coding, clinical documentation integrity, health information management, charge capture, revenue integrity, denials prevention, reimbursement, and related functions.

• Plan and oversee small to medium-sized coding and middle revenue cycle projects and workstreams.

• Conduct evaluations of coding, clinical documentation integrity, health information management, and associated middle revenue cycle operations.

• Create project charters, work plans, staffing and budget plans, schedules, risk registers, client deliverables, and benefit realization models.

• Oversee project teams, assign tasks, review analyses and deliverables, and track scope, staffing, budgets, timelines, and engagement performance.

• Identify opportunities in operations, finance, compliance, workforce, and technology; formulate recommendations and implementation roadmaps.

• Present findings, recommendations, project updates, risks, and financial outcomes to client leaders.

• Evaluate coding accuracy, compliance, productivity, timeliness, reimbursement, and financial performance across inpatient, outpatient, professional fee, and ambulatory coding.

• Analyze workflows, staffing models, organizational structures, productivity standards, quality programs, management reporting, and performance management practices.

• Review health information management and clinical documentation integrity processes and governance.

• Investigate denials, clinical validation issues, claim edits, payment variances, backlogs, documentation deficiencies, incomplete records, and late charges.

• Assess coding audit and quality assurance programs, internal/outsourced/hybrid coding models, policies, procedures, and controls.

• Design and assist with future-state operating models, workflows, governance, performance standards, and monitoring tools.

• Analyze coding, documentation, billing, claims, denials, workforce, and financial data; create financial and benefit realization models.

• Develop dashboards, KPIs, management reports, and monitoring frameworks.

• Evaluate coding, documentation, billing, claims, revenue cycle, encoder, analytics, and related technology systems.

• Assess automation, natural language processing, AI-enabled workflows, and computer-assisted or autonomous coding capabilities.

• Support technology selection, implementation planning, workflow design, testing, adoption, training, and performance monitoring.

• Collaborate with technology, revenue cycle, clinical, compliance, finance, and operations teams.

• Build relationships with client executives and leaders in coding, health information management, clinical, compliance, and finance.

• Work in collaboration with BRG’s coding, documentation, revenue integrity, patient financial services, managed care, analytics, digital, and operations teams.

• Create analytical tools, benchmarks, implementation playbooks, templates, and supporting documentation.

• Assist with proposals, engagement scoping, pursuit presentations, client relationships, and follow-on opportunities.

• Contribute to articles, white papers, presentations, training, and thought leadership initiatives.

• Mentor junior professionals by providing feedback, development support, and delegated responsibilities.

⛳️ Requirements

• A minimum of five years of experience in healthcare consulting or industry roles related to coding, health information management, clinical documentation integrity, or similar middle revenue cycle functions.

• A bachelor’s or master’s degree, such as a BS, BBA, MBA, MHA, MA, or MS, preferably in health information management, healthcare administration, business administration, finance, accounting, nursing, or a related field.

• An active RHIA, RHIT, CCS, CCS-P, CPC, CIC, COC, or comparable coding or health information management credential.

• Proven experience in consulting, performance improvement, process redesign, organizational transformation, or implementation within coding or the middle revenue cycle.

• Demonstrated expertise in applying coding or health information management knowledge beyond production coding or routine coding quality reviews.

• Experience leading assessments and implementation initiatives, managing multiple workstreams, and delivering projects within scope, budget, and timeline expectations.

• Proven ability to lead project teams, mentor junior professionals, assign tasks, and review work outputs.

• Operational expertise in facility inpatient, facility outpatient, professional fee or ambulatory coding; health information management; clinical documentation integrity; computer-assisted or autonomous coding; coding quality and compliance; coding-related denials; discharged-not-final-billed management; or charge capture and revenue integrity.

• Up-to-date knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, modifiers, and relevant official coding guidelines.

• Familiarity with Medicare IPPS, OPPS, professional fee, and ambulatory reimbursement methodologies.

• Understanding of MS-DRG and APC assignment, severity capture, risk adjustment, and the financial and quality implications of coding and documentation practices.

• Experience evaluating coding productivity, quality, turnaround times, staffing capacity, organizational structures, vendor performance, and management oversight.

• Knowledge of coding-related denials, clinical validation, medical necessity, claim edits, and payment variance root-cause analysis.

• Strong grasp of regulatory and compliance requirements influencing coding, documentation, billing, reimbursement, and health information management.

• Experience analyzing large healthcare datasets and transforming findings into actionable financial, operational, and compliance recommendations.

• Excellent written, verbal, and presentation skills.

• Capability to lead client meetings, facilitate discussions among stakeholders, and build consensus around recommended changes.

• Ability to balance coding requirements with operational feasibility, financial impact, compliance risks, and organizational priorities.

• Proficiency in managing multiple responsibilities, workstreams, and deadlines in a consulting environment.

• Advanced skills in Microsoft Excel and PowerPoint, along with proficiency in Word and Outlook.

• Familiarity with electronic health record, patient accounting, encoder, computer-assisted coding, clinical documentation integrity, health information management, and revenue cycle systems.

• Additional credentials such as CCDS, CDIP, CPMA, CHDA, PMP, Lean Six Sigma, CHFP, or CRCR are preferred.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health and wellness programs.

• Opportunities for professional development and career advancement.

• Flexible work arrangements and a supportive work environment.