Pro JTS - Revenue Integrity Consultant

Key Responsibilities

Client Delivery (Hands-On Execution Focus)

• Assessments & Audits: Perform detailed revenue integrity assessments across hospital and/or physician revenue cycle operations. Execute comprehensive audits of charge capture, coding, documentation, billing, and reimbursement processes.
• Stakeholder Collaboration: Work directly with client staff (HIM, coding, revenue cycle, finance, and clinical departments) to resolve issues in real time.
• Relationship Management: Serve as a day-to-day client contact, building strong, trusted relationships across all organizational levels.

Revenue Recovery & Optimization

• Financial Identification: Identify and quantify missed revenue opportunities, underpayments, and process gaps.
• Recovery Efforts: Participate in or lead revenue recovery efforts, including retrospective reviews, rebilling, and appeals support.
• Workflow Optimization: Evaluate and optimize the Charge Description Master (CDM) and charging workflows. Analyze denials and determine root causes to prevent recurring issues.

Implementation & Results Ownership

• Execution Strategy: Support the execution and implementation of recommendations—focusing on practical, operational application rather than just high-level strategy.
• ROI Tracking: Develop practical, tailored solutions that fit each client’s operational realities. Track and report realized financial impact and ROI.
• Sustainability: Assist in building sustainable processes, internal controls, and monitoring tools.

Data Analysis & Reporting

• Data Mining: Analyze complex client data sets to identify trends, anomalies, and performance gaps.
• Dashboards & Reporting: Build clear, client-ready reports and dashboards to tell a compelling financial and operational story using data.

Firm Contribution

• Business Development: Support business development efforts, including proposal input, scoping, and client presentations.
• IP Development: Contribute to the development of proprietary tools, methodologies, and internal intellectual property.
• Mentorship: Mentor junior staff and collaborate effectively within small, high-performing teams.

Qualifications & Requirements

Education & Certifications

• Degree: Bachelor’s degree in Health Information Management (HIM), Healthcare Administration, Finance, or a related field required.
• Required Professional Certifications (At least one or more):
  • RHIA (Registered Health Information Administrator) or RHIT (Registered Health Information Technician)
  • CCS (Certified Coding Specialist), CPC (Certified Professional Coder), or equivalent coding certification
• Preferred Certifications: CHC (Certified in Healthcare Compliance) or CHFP (Certified Healthcare Financial Professional) are a strong plus.

Professional Experience

• 4–8+ years of hands-on healthcare revenue cycle or revenue integrity experience.
• Strong preference given to candidates with:
  • Direct hospital or health system experience
  • A proven track record in audit and/or revenue recovery work
  • Prior healthcare consulting experience

Skills & Competencies

Technical Expertise

• Deep knowledge of charge capture processes and coding systems (ICD-10, CPT, HCPCS).
• Strong understanding of reimbursement methodologies (DRG, APC, OPPS, and professional billing).
• Hands-on experience with major EHRs (Epic, Cerner, Meditech) and standard revenue cycle systems.

Analytical & Core Strengths

• Advanced Excel Skills: Mastery of pivot tables, VLOOKUPs, and advanced data analysis tools to connect datasets to financial outcomes.
• Self-Starter Mindset: Ability to work independently with minimal structure, take initiative, and "roll up your sleeves" to execute tasks.
• Attention to Detail: Meticulous focus on accuracy, compliance, and regulatory standards.

Client-Facing Communication

• Ability to communicate financial and technical findings clearly to both frontline staff and health system executives.
• Strong interpersonal skills to build trust quickly in a consultant-client dynamic.