Managing Consultant - Healthcare Performance Improvement (Revenue Integrity)

Job title and compensation to be determined based on qualifications and experience.    

Responsibilities 

• Assess and analyze charge generation and charge capture workflows to identify potential revenue leakage issue(s) and/or compliance risks 

• Review and/or draft Revenue Integrity related policies and procedures to identify improvement recommendations 

• Perform detailed research and analysis (e.g., gather, review, and summarize literature and data from the public domain, specialized industry resources, or client, public, and commercial databases).   

• Demonstrate creativity and efficient use of relevant software tools, analytical methods, and computer models to develop solutions.   

• Develop analyses and financial models using transactional data, financial data, and/or client provided data.   

• Develop and execute workplans for assigned project work 

• Draft client deliverables for review by project lead/manager  

• Work collaboratively with internal Revenue Integrity team members to develop methodology and documentation 

• Participate in a team environment and prioritize assignments and responsibilities to meet goals and deadlines; facilitate internal meetings as appropriate 

Qualifications  

• A Bachelor’s or Master’sdegree (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 Managementor related discipline.  

• 4-8 years of consulting and/or industry work experience in Revenue Integrity and/or Charge Integrityincluding performance and process improvement, revenue management and redesign, and reimbursement and recovery strategies. Job title and compensation to be determined based on qualifications and experience.    

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

• Understanding of the Medicare IPPS, OPPS and ASC payment systems 

• Understanding of documentation and various charge capture and charge generation processes across high-volume, revenue-producing hospital departments 

• Understanding of charge reconciliation processes 

• Familiarity with compliance principles as related to Revenue and Charge Integrity 

• Familiarity with regulatory changes that impact charging practices 

• Familiarity with clinical operations and billing office workflows 

• Strong verbal and written communication and presentation skills 

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

• Applicable 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) 

Willing to travel consistently(50% - 75%, depending on project requirements and client expectations) is required for this position.  

Candidate must be able to submit verification of his/her legal right to work in the U.S., without company sponsorship.  

Consultant Salary Range: $90,000 – $135,000 per year. 

Managing Consultant Salary Range: $120,000 – $165,000 per year

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