Overview

We are seeking an experienced healthcare revenue cycle management (RCM) professional to join a consulting team for a six-month engagement, dedicating 1-2 days per week. The ideal candidate will have extensive experience in acute care hospital settings and a deep understanding of how Clinical Documentation Integrity (CDI) and Utilization Management (UM) drive RCM performance and financial outcomes.

Qualifications:

Revenue Cycle Expertise:

Comprehensive knowledge of end-to-end hospital revenue cycle processes, including patient access, clinical documentation, coding, billing, and reimbursement.

Demonstrated success in improving revenue cycle performance through optimized CDI and UM practices.

CDI Knowledge:

Expertise in CDI programs, focusing on accurate and complete documentation to support coding, billing, and compliance requirements.

Familiarity with coding standards (e.g., ICD-10) and their impact on revenue cycle metrics, including Case Mix Index (CMI) and reimbursement.

UM Knowledge:

Strong understanding of utilization management and its influence on revenue, including processes for medical necessity, length of stay, and payer communication.

Ability to identify and mitigate issues that delay or deny claims.

Hospital Setting Experience:

Significant experience working within or consulting for acute care hospitals, with a focus on RCM-related challenges.

Familiarity with operational and financial metrics critical to hospital performance.

Analytical and Strategic Skills:

Proven ability to analyze RCM data to uncover trends, identify root causes of underperformance, and recommend actionable improvements.

Experience developing strategies to integrate CDI and UM into the broader revenue cycle framework to enhance financial outcomes.

Consulting Expertise:

Prior experience with project-based consulting engagements in healthcare, particularly those involving RCM optimization.

Ability to work collaboratively with clinical, administrative, and revenue cycle teams to drive meaningful change.

Project Overview:

• Duration: Approximately 6 months.
• Commitment: 1-2 days per week.
• Scope: Partner with a software provider serving acute care hospitals to assess and refine their solutions, focusing on the integration and impact of CDI and UM processes on RCM performance.

This role is an opportunity for an RCM expert to leverage their knowledge and experience in hospital operations, CDI, and UM to improve financial and operational outcomes for healthcare organizations