Managing Consultant – Revenue Integrity, Healthcare

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

📋 Description

• Oversee and coordinate small to medium-sized Revenue Integrity projects and specific workstreams within broader, multidisciplinary engagements.

• Direct initiatives throughout the Revenue Integrity spectrum, which includes Charge Description Master governance, charge capture, charge reconciliation, compliance with charging, prevention of revenue integrity-related denials, and realization of financial opportunities.

• Conduct current-state evaluations of Revenue Integrity operations, quantify financial and compliance opportunities, identify root causes, and formulate prioritized recommendations along with implementation roadmaps.

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

• Review and formulate Revenue Integrity-related policies and procedures while suggesting areas for enhancement.

• Cultivate and sustain relationships with client executives, operational leaders, and other essential stakeholders throughout the lifecycle of the engagement.

• Utilize relevant technology, analytical techniques, and financial models to create practical, data-driven solutions.

• Generate analyses and financial models leveraging transactional, financial, and client-supplied data.

• Create and oversee project charters, work plans, budgets, staffing strategies, timelines, risk assessments, deliverables, and benefit realization models and schedules.

• Track performance against financial, operational, and compliance benchmarks to facilitate project execution and engagement profitability.

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

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

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

• Lead project teams, assign responsibilities, monitor progress, facilitate internal and client meetings, and review work products.

• Present findings, recommendations, project advancements, risks, and financial outcomes to senior client stakeholders, including Revenue Cycle executives, compliance leaders, clinical leaders, CFOs, and other executive leaders.

⛳️ Requirements

• Must be willing to travel frequently (50%–80%), based on project requirements and client expectations.

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

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

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

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

• Familiarity with Medicare IPPS, OPPS, and ASC payment systems.

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

• Knowledge of charging, coding, billing, reimbursement, compliance, and price transparency requirements.

• Acquainted with clinical operations and patient financial services workflows.

• Excellent written, verbal, and presentation skills.

• 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 (e.g., RHIA, RHIT, CPC, COC, CCS, CRIP, or other AHIMA / AAPC / AAHAM certifications).

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

🏝️ Benefits

• Competitive salary and performance-based bonuses.

• Comprehensive health, dental, and vision insurance.

• Opportunities for professional development and continuing education.

• Flexible working hours and remote work options.

• Supportive and inclusive work environment.