Managing Consultant – Revenue Integrity – Healthcare
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Job Description
Managing Consultant improving healthcare revenue integrity for BRG clients. Leading financial analyses, process redesign, compliance initiatives, and consulting engagements.
Responsibilities:
- Plan and manage small- to medium-sized Revenue Integrity engagements and discrete workstreams within larger multidisciplinary engagements
- Lead initiatives across Charge Description Master governance, charge capture, charge reconciliation, charging compliance, revenue integrity-related denials prevention, and financial opportunity realization
- Lead current-state assessments of Revenue Integrity operations
- Quantify financial and compliance opportunities, identify root causes, and develop prioritized recommendations and implementation roadmaps
- Assess and analyze charge-generation and charge-capture workflows to identify revenue leakage and compliance risks
- Review and draft Revenue Integrity-related policies and procedures and recommend improvements
- Develop and maintain relationships with client executives, operational leaders, and key stakeholders
- Apply technology, analytical methods, and financial models to develop data-driven solutions
- Develop analyses and financial models using transactional, financial, and client-provided data
- Develop and manage project charters, work plans, budgets, staffing plans, timelines, risks, deliverables, and benefit realization models and schedules
- Monitor performance against financial, operational, and compliance targets to support project execution and engagement profitability
- Lead design and implementation of future-state Revenue Integrity processes, governance structures, controls, policies, and monitoring tools
- Lead development, quality review, and presentation of client deliverables, findings, and recommendations
- Collaborate with Revenue Integrity team members to develop methodologies, analytical tools, implementation playbooks, and supporting documentation
- Lead project teams, delegate responsibilities, monitor progress, facilitate meetings, and review work products
- Present findings, recommendations, project progress, risks, and financial results to senior client stakeholders
Requirements:
- 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 related discipline
- 5+ years of consulting and/or industry experience in Revenue Integrity, Charge Integrity, or related revenue cycle functions
- Demonstrated experience 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 improvement, pricing, reimbursement, and/or charging compliance
- Working knowledge of Medicare IPPS, OPPS, and ASC payment systems and their impact on charging, coding, billing, and reimbursement practices
- Working knowledge of clinical documentation, charge-generation, charge-capture, and charge-reconciliation processes across high-volume, revenue-producing hospital departments
- Working knowledge of applicable charging, coding, billing, reimbursement, compliance, and price transparency requirements
- Ability to assess operational and financial impact of regulatory changes
- Familiarity with clinical operations and patient financial services workflows
- Strong written, verbal, and presentation skills
- Strong proficiency in Microsoft Office applications, including Word, PowerPoint, Excel, and Outlook
- Familiarity with various EMRs, including Epic, Oracle Health/Cerner, Altera/Allscripts, MEDITECH, and athenahealth/IDX
- Applicable industry certification is preferred, such as RHIA, RHIT, CPC, COC, CCS, CRIP, or other AHIMA/AAPC/AAHAM certification
- Ability to travel 50% to 75%, depending on project requirements and client expectations
- Must be able to submit verification of legal right to work in the U.S. without company sponsorship
Benefits:
- Equal Opportunity Employer
- Reasonable accommodation for essential job functions
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