Revenue Integrity Consultant

This is a fully remote position, open to applicants in California, +1 more state.

📋 Description

• Collaborate with client teams to evaluate existing revenue integrity processes and pinpoint areas for enhancement

• Deliver extensive Chargemaster (CDM) expertise in both Hospital Billing (HB) and Professional Billing (PB)

• Examine CDM structure, maintenance, and processes to uncover revenue leakage, charging discrepancies, and charge capture opportunities

• Assess and align revenue codes with both hard-coded and soft-coded charging requirements

• Analyze charging workflows and offer strategic recommendations to bolster revenue integrity and compliance

• Assist in optimizing CDM management, maintenance, and integration with clinical and financial Epic modules

• Implement revenue integrity best practices to aid charge capture, ensure billing accuracy, and prevent denials

• Review revenue cycle processes for hospital billing compliance and detect potential audit risks

• Facilitate revenue integrity assessments, implementations, optimization projects, and post-live stabilization

• Work collaboratively with operational, clinical, financial, and IT stakeholders to create effective solutions

• Present findings, recommendations, and project progress to client leadership and project teams

• Adjust to diverse client requirements and support various project areas as necessary

• Contribute to The Wilshire Group through knowledge sharing, teamwork, and ongoing professional development

⛳️ Requirements

• Over 10 years of experience in revenue integrity within a hospital or health system setting

• In-depth knowledge of Epic Hospital Billing (HB), especially related to charging and charge capture

• Familiarity with Epic Professional Billing (PB) functionalities

• Thorough understanding of Chargemaster management and revenue integrity operations

• Practical knowledge of CPT coding and its relevance in revenue integrity operations

• Proven track record in identifying and resolving charging, billing, and revenue leakage issues

• Awareness of hospital billing compliance, audits, and strategies for denial prevention

• Experience in supporting Epic implementations, optimization efforts, or post-live initiatives

• Strong analytical, problem-solving, and consulting capabilities

• Exceptional written and verbal communication skills

• Capacity to effectively engage with client stakeholders at various levels

• Proven ability to work independently, juggle competing priorities, and adapt to evolving client needs

• Bachelor's degree or an equivalent mix of education and relevant experience

• While Epic certification is not a requirement for this position, operational experience is prioritized

• Required experience in CDM Consolidation for a new install or an Epic Refuel

🏝️ Benefits

• No benefits are provided for the contracted interim position

• Opportunity to engage within a professional healthcare consulting environment

• Potential for contract-to-hire for local candidates in Texas, if desired

• Opportunities for professional development and knowledge sharing