Managing Consultant – Revenue Integrity – Healthcare

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

📋 Description

• Plan and oversee small- to medium-sized Revenue Integrity projects and specific workstreams within larger multidisciplinary initiatives.

• Spearhead efforts related to Charge Description Master governance, charge capture, charge reconciliation, compliance in charging, prevention of revenue integrity-related denials, and realization of financial opportunities.

• Conduct current-state assessments of Revenue Integrity operations.

• Quantify financial and compliance opportunities, pinpoint root causes, and formulate prioritized recommendations along with implementation roadmaps.

• Evaluate and analyze workflows for charge generation and charge capture to detect revenue leakage and compliance risks.

• Review and draft policies and procedures related to Revenue Integrity and suggest enhancements.

• Establish and nurture relationships with client executives, operational leaders, and key stakeholders.

• Utilize technology, analytical methods, and financial models to create data-driven solutions.

• Conduct analyses and develop financial models using transactional, financial, and client-supplied data.

• Create and manage project charters, work plans, budgets, staffing plans, timelines, risks, deliverables, and models and schedules for benefit realization.

• Monitor performance relative to financial, operational, and compliance goals to support project execution and profitability of engagements.

• Direct the design and implementation of future-state Revenue Integrity processes, governance frameworks, controls, policies, and monitoring tools.

• Lead the development, quality review, and presentation of client deliverables, findings, and recommendations.

• Collaborate with Revenue Integrity team members to formulate methodologies, analytical tools, implementation playbooks, and supporting documentation.

• Lead project teams by delegating tasks, monitoring progress, facilitating meetings, and reviewing work products.

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

⛳️ Requirements

• Bachelor’s or Master’s degree (e.g., BS, BBA, MBA, MHA, M.A., M.S., etc.) preferably focused on Management, Accounting, Finance, Healthcare Administration, Business Administration, Health Information Management, or a related field.

• Over 5 years of consulting and/or industry experience in Revenue Integrity, Charge Integrity, or related revenue cycle functions.

• Proven experience leading performance improvement, process redesign, reimbursement, and revenue recovery projects.

• Operational expertise in Charge Description Master governance and maintenance, charge capture, charge reconciliation, Revenue Integrity, denials prevention, HIM/coding, outpatient clinical documentation improvement, pricing, reimbursement, and/or compliance in charging.

• Familiarity with Medicare IPPS, OPPS, and ASC payment systems and their influence on charging, coding, billing, and reimbursement practices.

• Knowledge of clinical documentation, charge generation, charge capture, and charge reconciliation processes within high-volume, revenue-generating hospital departments.

• Understanding of applicable requirements for charging, coding, billing, reimbursement, compliance, and price transparency.

• Ability to evaluate the operational and financial impacts of regulatory changes.

• Familiarity with clinical operations and patient financial services workflows.

• Excellent written, verbal, and presentation capabilities.

• Strong proficiency in Microsoft Office applications, including Word, PowerPoint, Excel, and Outlook.

• Familiarity with various EMRs, such as Epic, Oracle Health/Cerner, Altera/Allscripts, MEDITECH, and athenahealth/IDX.

• Relevant industry certification is preferred, such as RHIA, RHIT, CPC, COC, CCS, CRIP, or other certifications from AHIMA/AAPC/AAHAM.

• Willingness to travel 50% to 75%, based on project demands and client expectations.

• Must be able to provide verification of legal eligibility to work in the U.S. without company sponsorship.

🏝️ Benefits

• Equal Opportunity Employer

• Reasonable accommodations for essential job functions.