Revenue Cycle Managed Services - Revenue Integrity Lead

<h3>Accountabilities:</h3><li>
<strong>Revenue integrity leadership:</strong>Lead and manage consulting engagements focused on revenue integrity, revenue optimization, charge capture, reimbursement accuracy, and revenue cycle transformation for hospitals, health systems, physician groups, and other healthcare providers.</li><li>
<strong>Revenue cycle assessment:</strong>Conduct comprehensive evaluations of revenue cycle operations, billing practices, charge capture workflows, and reimbursement processes to identify performance gaps, financial risks, and opportunities for improvement.</li><li>
<strong>Revenue optimization and recovery:</strong>Identify revenue leakage and lead initiatives to improve charge capture, enhance clinical documentation collaboration, reduce denials, increase billing accuracy, accelerate cash flow, and maximize appropriate reimbursement.</li><li>
<strong>Financial analysis and performance monitoring:</strong>Analyze charge master data, pricing methodologies, payer contract performance, reimbursement trends, claims, denials, and utilization data. Develop KPI dashboards, benchmarking frameworks, and monitoring strategies to track results.</li><li>
<strong>Compliance and regulatory oversight:</strong>Evaluate charging and billing practices against Medicare, Medicaid, commercial payer requirements, and applicable regulations. Identify audit risks, recommend corrective actions, and support audit preparation, remediation, and revenue integrity governance.</li><li>
<strong>Strategic consulting and client engagement:</strong>Serve as a trusted advisor to healthcare executives and operational leaders. Facilitate workshops, present findings, lead strategic planning sessions, and develop implementation roadmaps that align with client objectives.</li><li>
<strong>Project management and delivery:</strong>Develop project plans, coordinate multidisciplinary teams, manage timelines, and ensure the successful delivery of revenue improvement and transformation initiatives.</li><li>
<strong>Technology optimization:</strong>Recommend enhancements to electronic health records (EHRs), billing systems, and revenue cycle platforms to improve workflows, data quality, operational efficiency, and financial performance.</li><li>
<strong>Team leadership and knowledge sharing:</strong>Mentor consultants, analysts, and other team members on revenue integrity best practices. Contribute to consulting methodologies, thought leadership, solution development, and business development activities, including proposals and client presentations.</li><h2>Requirements:</h2><li>Industry-relevant certification in healthcare revenue integrity, such as<strong>Certified in Healthcare Revenue Integrity (CHRI)</strong>,<strong>Certified Revenue Integrity Professional (CRIP)</strong>, or an equivalent credential.</li><li>At least<strong>8 years of experience in healthcare revenue cycle management</strong>, including a minimum of<strong>5 years of direct experience in revenue integrity, revenue cycle consulting, revenue optimization, or related healthcare financial operations</strong>.</li><li>Demonstrated experience leading complex healthcare improvement initiatives and delivering measurable financial or operational results.</li><li>Strong expertise in revenue integrity programs, charge capture, chargemaster (CDM) management, denial management, revenue recovery, revenue cycle operations, and revenue compliance.</li><li>Comprehensive knowledge of Medicare and Medicaid reimbursement, commercial payer reimbursement practices, and relevant regulatory requirements.</li><li>Familiarity with clinical documentation improvement concepts and their relationship to appropriate reimbursement and revenue integrity.</li><li>Advanced analytical and problem-solving skills, including the ability to interpret complex financial and operational data, identify revenue opportunities, and develop practical recommendations.</li><li>Excellent executive communication and presentation skills, with the ability to explain complex findings, influence stakeholders, and build trusted client relationships.</li><li>Strong project management, leadership, and collaboration skills, including experience coordinating clinical, finance, revenue cycle, compliance, and IT stakeholders.</li><h2>Preferred qualifications:</h2><li>A bachelor's or master's degree in Healthcare Administration (MHA), Business Administration (MBA), Finance, or a related discipline.</li><li>Previous experience working within a healthcare management consulting firm.</li><li>Additional professional certifications, including those offered by the Healthcare Financial Management Association (HFMA).</li><li>Experience with healthcare technology platforms such as Epic, Cerner, Oracle Health, or MEDITECH.</li><li>Experience supporting large integrated delivery networks, academic medical centers, or complex healthcare systems.</li><li>Demonstrated ability to contribute to business development, consulting solution design, and the development of scalable revenue integrity methodologies.</li><h2>Benefits:</h2><li>
<strong>Performance-based compensation:</strong>Eligibility for an annual performance bonus may be available for salaried positions, subject to applicable employment terms.</li><li>
<strong>Additional benefits and perks:</strong>Other benefits may be available depending on the position and the terms of employment.</li><li>
<strong>Remote work flexibility:</strong>Fully remote position based in the United States.</li><li>
<strong>Professional development:</strong>Opportunities to strengthen expertise in healthcare revenue integrity, financial optimization, consulting, and revenue cycle transformation.</li><li>
<strong>Leadership opportunities:</strong>The ability to mentor professionals, contribute to consulting methodologies, and influence strategic initiatives across healthcare organizations.</li><li>
<strong>Meaningful impact:</strong>Help hospitals and healthcare providers improve financial sustainability, strengthen compliance, and optimize revenue cycle performance.</li><li>
<strong>Collaborative culture:</strong>Work alongside multidisciplinary professionals in a supportive environment that values integrity, accountability, autonomy, and teamwork.</li><li>
<strong>Inclusive workplace:</strong>A commitment to diversity, inclusion, and ensuring that employees feel valued and empowered.</li><li>
<strong>Career advancement:</strong>Opportunities to contribute to thought leadership, business development, and innovative healthcare consulting solutions.</li>