Revenue Integrity Consultant

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🔥 0 minutes ago

🏄 California, Texas – Remote

🏄 California – Remote 🤠 Texas – Remote

💵 $60 - $65 / hour

⏰ Full Time

🟠 Senior

🔴 Lead

💼 Consultant

👻 Ghost score 0%

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The Wilshire Group

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💼 Consulting

Healthcare • Healthcare Insurance • Consulting

The Wilshire Group is a consultancy firm that specializes in optimizing revenue cycle operations and IT solutions for the healthcare industry. They provide services in patient access, health information management, revenue integrity, and billing for both hospital and professional settings. The firm focuses on enhancing financial experiences by partnering with clients to solve complex challenges at the intersection of operations and technology. The Wilshire Group is dedicated to helping organizations maximize their EHR investments and improve revenue recognition and workflow optimization, ensuring consistent and proven results.

📋 Description

• Partner with client teams to assess current revenue integrity processes and identify improvement opportunities • Provide comprehensive Chargemaster (CDM) expertise across Hospital Billing (HB) and Professional Billing (PB) • Review CDM structure, maintenance, and processes to identify revenue leakage, charging issues, and charge-capture opportunities • Evaluate and align revenue codes with hard-coded and soft-coded charging requirements • Analyze charging workflows and provide strategic recommendations to improve revenue integrity and compliance • Support optimization of CDM management, maintenance, and integration with clinical and financial Epic modules • Apply revenue integrity best practices to support charge capture, billing accuracy, and denial prevention • Review revenue cycle processes for hospital billing compliance and identify potential audit risks • Support revenue integrity assessments, implementations, optimization projects, and post-live stabilization • Collaborate with operational, clinical, financial, and IT stakeholders to develop practical solutions • Communicate findings, recommendations, and project status to client leadership and project teams • Adapt to varying client needs and support multiple project areas when needed • Contribute to The Wilshire Group through knowledge sharing, collaboration, and professional development

🎯 Requirements

• 10+ years of revenue integrity experience within a hospital or health system environment • Strong knowledge of Epic Hospital Billing (HB), particularly related to charging and charge capture • Knowledge of Epic Professional Billing (PB) functionality • Comprehensive knowledge of Chargemaster management and revenue integrity operations • Working knowledge of CPT coding and its application within revenue integrity operations • Experience identifying and addressing charging, billing, and revenue leakage opportunities • Knowledge of hospital billing compliance, audits, and denial prevention strategies • Experience supporting Epic implementations, optimization, or post-live initiatives • Strong analytical, problem-solving, and consulting skills • Excellent written and verbal communication skills • Ability to work effectively with client stakeholders at multiple levels • Ability to work independently, manage competing priorities, and adapt to changing client needs • Bachelor's degree or equivalent combination of education and relevant experience • Epic certification is not required for this role; operational-side experience is more important • CDM Consolidation experience for a new install or an Epic Refuel is required

🏖️ Benefits

• No benefits offered for the contracted interim position • Opportunity to work within a professional healthcare consulting environment • Contract-to-hire possibility for those local to Texas, if interested • Professional development and knowledge-sharing opportunities