Managing Consultant – Revenue Integrity, Healthcare

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

📋 Description

• Evaluate and analyze charge generation and charge capture processes to pinpoint potential revenue leakage issues and/or compliance risks.

• Review and/or create policies and procedures related to Revenue Integrity to propose improvement recommendations.

• Conduct in-depth research and analysis (e.g., collect, assess, and summarize literature and data from public sources, specialized industry references, or client, public, and commercial databases).

• Exhibit creativity and effective utilization of relevant software tools, analytical techniques, and computer models to formulate solutions.

• Create analyses and financial models using transactional data, financial data, and/or client-supplied data.

• Design and implement workplans for assigned project tasks.

• Prepare client deliverables for evaluation by the project lead/manager.

• Collaborate effectively with internal Revenue Integrity team members to establish methodology and documentation.

• Engage in a team-oriented environment and prioritize assignments and responsibilities to achieve objectives and deadlines; facilitate internal meetings as necessary.

⛳️ Requirements

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

• 4-8 years of consulting and/or industry experience in Revenue Integrity and/or Charge Integrity, including performance and process enhancement, revenue management and redesign, and reimbursement and recovery strategies.

• Operational expertise primarily focused on Charge Description Master (CDM) Management, Charge Capture, Revenue Integrity, Denials Prevention, HIM/Coding/Outpatient Clinical Documentation Improvement, Denials Prevention, and Payer Contracting.

• Knowledge of the Medicare IPPS, OPPS, and ASC payment systems.

• Familiarity with documentation and various charge capture and charge generation processes within high-volume, revenue-generating hospital departments.

• Understanding of charge reconciliation processes.

• Acquaintance with compliance principles as they pertain to Revenue and Charge Integrity.

• Awareness of regulatory changes affecting charging practices.

• Understanding of clinical operations and billing office workflows.

• Excellent verbal and written communication and presentation skills.

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

• Relevant industry certification is preferred (e.g., RHIA, RHIT, CPC, COC, CCS, CRIP or other AHIMA / AAPC / AAHAM certification).

• Familiarity with various EMRs (e.g., Epic, Cerner, Allscripts, MEDITECH, Athena/IDX).

🏝️ Benefits

• Health insurance

• Flexible working hours

• Professional development opportunities