Managing Consultant – Coding, Middle Revenue Cycle, Healthcare

🕒 Setembro 29

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $120.000 - $165.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

💼 Consultor

👻 Score fantasma 1%

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Berkeley Research Group (BRG)

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

🏗️ Construção

📦 Logística

🎖️ Defesa

💰 Venture Round em 2020-07

Construction • Logistics • Defense

A BRG combina credenciais acadêmicas de renome mundial com expertise empresarial testada em campo, criada para agilidade e conectividade, o que nos diferencia e coloca nossos clientes à frente. Nossos especialistas de primeira linha incluem líderes experientes da indústria, acadêmicos renomados e cientistas de dados pioneiros. Juntos, eles trazem uma diversidade de experiências comprovadas do mundo real para economia, disputas e investigações; finanças corporativas; e serviços de melhoria de desempenho que abordam os desafios mais complexos para organizações ao redor do mundo. Nossa estrutura única nutre os relacionamentos interdisciplinares que nos dão a vantagem, estabelecendo as bases para insights mais informados e pensamentos mais originais e incisivos de perspectivas diversas que, quando combinados com nosso alcance e recursos globais, nos tornam exclusivamente capazes de enfrentar os desafios de nossos clientes.

Descrição

• Lead and support qualitative and quantitative engagements focused on coding accuracy, compliance, productivity, timeliness, reimbursement, and financial performance • Support expansion of BRG’s middle revenue cycle capabilities across coding, clinical documentation integrity, health information management, charge capture, revenue integrity, denials prevention, reimbursement, and related functions • Plan and manage small- to medium-sized coding and middle revenue cycle engagements and workstreams • Lead assessments of coding, clinical documentation integrity, health information management, and related middle revenue cycle operations • Develop project charters, work plans, staffing and budget plans, schedules, risk registers, client deliverables, and benefit realization models • Manage project teams, delegate work, review analyses and deliverables, and monitor scope, staffing, budgets, timelines, and engagement performance • Identify operational, financial, compliance, workforce, and technology opportunities; develop recommendations and implementation roadmaps • Present findings, recommendations, project progress, risks, and financial results to client leaders • Assess coding accuracy, compliance, productivity, timeliness, reimbursement, and financial performance across inpatient, outpatient, professional fee, and ambulatory coding • Evaluate workflows, staffing models, organizational structures, productivity standards, quality programs, management reporting, and performance management practices • Assess health information management and clinical documentation integrity processes and governance • Analyze denials, clinical validation issues, claim edits, payment variances, backlogs, documentation deficiencies, incomplete records, and late charges • Evaluate coding audit and quality assurance programs, internal/outsourced/hybrid coding models, policies, procedures, and controls • Design and support future-state operating models, workflows, governance, performance standards, and monitoring tools • Analyze coding, documentation, billing, claims, denials, workforce, and financial data; develop financial and benefit realization models • Build dashboards, KPIs, management reports, and monitoring frameworks • Assess coding, documentation, billing, claims, revenue cycle, encoder, analytics, and related technology systems • Evaluate automation, natural language processing, AI-enabled workflows, computer-assisted and autonomous coding capabilities • Support technology selection, implementation planning, workflow design, testing, adoption, training, and performance monitoring • Coordinate with technology, revenue cycle, clinical, compliance, finance, and operations teams • Build relationships with client executives and coding, health information management, clinical, compliance, and finance leaders • Collaborate across BRG’s coding, documentation, revenue integrity, patient financial services, managed care, analytics, digital, and operations teams • Develop analytical tools, benchmarks, implementation playbooks, templates, and supporting documentation • Support proposals, engagement scoping, pursuit presentations, client relationships, and follow-on opportunities • Contribute to articles, white papers, presentations, training, and thought leadership • Coach junior professionals through feedback, development support, and delegated responsibility

🎯 Requisitos

• Five or more years of healthcare consulting or industry experience in coding, health information management, clinical documentation integrity, or related middle revenue cycle functions • A bachelor’s or master’s degree, such as a BS, BBA, MBA, MHA, MA, or MS, preferably in health information management, healthcare administration, business administration, finance, accounting, nursing, or a related discipline • An active RHIA, RHIT, CCS, CCS-P, CPC, CIC, COC, or comparable coding or health information management credential • Demonstrated consulting, performance improvement, process redesign, organizational transformation, or implementation experience in coding or the middle revenue cycle • Experience applying coding or health information management expertise beyond production coding or routine coding quality review • Experience leading assessments and implementation initiatives, managing concurrent workstreams, and delivering projects within scope, budget, and schedule expectations • Experience leading project teams, mentoring junior professionals, delegating assignments, and reviewing work products • Operational expertise in facility inpatient, facility outpatient, professional fee or ambulatory coding; health information management; clinical documentation integrity; computer-assisted or autonomous coding; coding quality and compliance; coding-related denials; discharged-not-final-billed management; or charge capture and revenue integrity • Current working knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, modifiers, and applicable official coding guidelines • Working knowledge of Medicare IPPS, OPPS, professional fee, and ambulatory reimbursement methodologies • Knowledge of MS-DRG and APC assignment, severity capture, risk adjustment, and financial and quality effects of coding and documentation practices • Experience assessing coding productivity, quality, turnaround time, staffing capacity, organizational structure, vendor performance, and management oversight • Familiarity with coding-related denials, clinical validation, medical necessity, claim edits, and payment variance root-cause analysis • Working knowledge of regulatory and compliance requirements affecting coding, documentation, billing, reimbursement, and health information management • Experience analyzing large healthcare datasets and turning findings into financial, operational, and compliance recommendations • Strong written, verbal, and presentation skills • Ability to lead client meetings, facilitate stakeholder discussions, and build agreement around recommended changes • Ability to balance coding requirements with operational feasibility, financial impact, compliance risk, and organizational priorities • Ability to manage multiple responsibilities, workstreams, and deadlines in a consulting environment • Advanced proficiency in Microsoft Excel and PowerPoint, and proficiency in Word and Outlook • Familiarity with electronic health record, patient accounting, encoder, computer-assisted coding, clinical documentation integrity, health information management, and revenue cycle systems • Additional credentials such as CCDS, CDIP, CPMA, CHDA, PMP, Lean Six Sigma, CHFP, or CRCR are preferred

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