Healthcare Consultant Jobs

About The Position

Requirements

• Bachelor’s or master’s degree in a relevant discipline, such as Management, Accounting, Finance, Healthcare Administration, Business Administration, or Health Information Management.
• At least 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 at least one area such as Charge Description Master governance and maintenance, charge capture or reconciliation, Revenue Integrity, denial prevention, HIM/coding, outpatient clinical documentation improvement, pricing, reimbursement, or charging compliance.
• Working knowledge of Medicare IPPS, OPPS, and ASC payment systems and their effects on charging, coding, billing, and reimbursement.
• 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, including assessing the operational and financial effects of regulatory changes.
• Familiarity with clinical operations and patient financial services workflows.
• Strong written, verbal, and presentation skills, including the ability to communicate complex findings and recommendations to executive, operational, clinical, and compliance stakeholders.
• Strong proficiency in Microsoft Word, PowerPoint, Excel, and Outlook.
• Ability to travel consistently 50%–80%, depending on project requirements and client expectations.
• Ability to verify legal authorization to work in the United States without company sponsorship.

Nice To Haves

• Bachelor’s or master’s degree focused on Management, Accounting, Finance, Healthcare Administration, Business Administration, Health Information Management, or a related discipline.
• Applicable industry certification, such as RHIA, RHIT, CPC, COC, CCS, CRIP, or another AHIMA, AAPC, or AAHAM certification.
• Familiarity with EMRs such as Epic, Oracle Health/Cerner, Altera/Allscripts, MEDITECH, and athenahealth/IDX.

Responsibilities

• Plan and manage small- to medium-sized Revenue Integrity engagements and discrete workstreams within larger multidisciplinary engagements.
• Lead initiatives across the Revenue Integrity continuum, including Charge Description Master governance, charge capture and reconciliation, charging compliance, denial 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 charge-generation and charge-capture workflows to identify potential revenue leakage and compliance risks.
• Review and draft Revenue Integrity-related policies and procedures and recommend improvements.
• Develop and maintain effective relationships with client executives, operational leaders, and other key stakeholders throughout engagements.
• Apply relevant technology, analytical methods, and financial models to develop practical, data-driven solutions to client challenges.
• 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 the design and implementation of future-state Revenue Integrity processes, governance structures, controls, policies, and monitoring tools.
• Lead the development, quality review, and presentation of client deliverables, findings, and recommendations.
• Collaborate with Revenue Integrity team members to develop and refine methodologies, analytical tools, implementation playbooks, and supporting documentation.
• Lead project teams, delegate responsibilities, monitor progress, facilitate internal and client meetings, and review work products for completeness, accuracy, and analytical rigor.
• Present findings, recommendations, project progress, risks, and financial results to senior client stakeholders, including Revenue Cycle executives, compliance and clinical leaders, CFOs, and other executives.
• Contribute to business development and practice growth.