Business Performance Optimization Revenue Integrity Consultant (Hybrid)

Education: Associate’s degree in Healthcare Administration, Finance, Business, Nursing, or related field, or In lieu of Associate’s degree, two (2) additional years of experience is required, for a total of seven (7) years of progressive experience in Revenue Cycle required.

Licenses/Certifications:

One of the following is required:

• Certified Professional Coder (CPC), or

• Certified Coding Specialist (CCS), or

• Certified Professional Biller (CPB)

These are preferred but not required:

• Certified Revenue Cycle Representative (CRCR), or

• Certified Healthcare Revenue Integrity (CHRI), or

• Project Management Professional (PMP), or

• Certified Lean Six Sigma

Experience / Knowledge / Skills:

• Five (5) years of progressive experience in Revenue Cycle required; experience in a consulting, analytics, or hospital system environment preferred. In lieu of Associate’s degree, two (2) additional years of experience is required, for a total of seven (7) years of progressive experience in Revenue Cycle required.

• Extensive knowledge of CPT/HCPCS/ICD-10, CMS process rules, payer reimbursement strategies, and workflow and process methodologies (DRG, APC, OPPS).

• Proficient in Epic (one or more Epic modules, especially Epic workflow and WQs), Microsoft Excel (pivot tables, formulas), and reporting tools (i.e. Tableau, Power BI, or SQL).

• Strong written and verbal communication and experience presenting to executive audiences.

• Proven success driving multi-stakeholder initiatives and optimizing revenue capture processes.

• Ability to lead complex assessments, manage projects, and influence cross-functional teams.

Principal Accountabilities

• Charge Capture Responsibilities:

  • Evaluates workflows and system configuration for missing, late, or duplicate workflow and processes.

  • Performs root cause analysis on workflow and process discrepancies and coordinates workflow and process reconciliation.

  • Recommends and implements workflow and documentation improvements to prevent leakage.

• Process Architecture & Pricing Responsibilities:

  • Collaborates with pricing and process architecture teams on annual price reviews, updates, and payer impact modeling.

  • Consults on workflow and process code additions, deletions, and revisions based on service line expansion or reimbursement updates.

  • Supports pricing strategies that maintain operational compliance and competitiveness.

• Data Analysis & Reporting Responsibilities:

  • Collaborates and uses data reporting resources to develop reports, dashboards, and variance analyses using Epic.

  • Interprets trends in revenue capture, claim process breakdowns or gaps, denial overturns, workflow and process lag, and payer mix shifts.

  • Provides actionable recommendations with measurable outcomes to clinical and finance stakeholders.

• Coding & Billing Compliance Responsibilities:

  • Identifies improper coding/documentation contributing to revenue variances.

  • Collaborates with coding, HIM, and operational compliance departments to ensure workflow and process and code integrity.

  • Assists with payer denial resolution strategy and monitors audit outcomes (internal and external).

• Project Management & Consulting Responsibilities:

  • Leads consulting engagements with operational and clinical teams on new initiatives (e.g., service expansion, provider onboarding, payer policy updates).

  • Provides subject matter expertise during system implementations and upgrades, including Epic optimization.

  • Tracks milestones, defines KPIs, mitigates risks, and ensures post-implementation sustainability.

• Collaboration & Training Responsibilities:

  • Provides training to department stakeholders on workflow and process policies, documentation expectations, Epic functionality, and revenue integrity standards.

  • Acts as a liaison between IT, Coding, Compliance, and Operational leaders to ensure aligned goals and effective communication.

  • Educates on current process and charging regulations, including No Surprises Act (NSA), GFE, and regulatory updates.

  • Supports continuous improvement projects across workflow and process review, process breakdowns or gaps management, and reimbursement accuracy.

• Additional Accountabilities:

  • Supports continuous improvement projects across workflow and process review, process breakdowns or gaps management, and reimbursement accuracy.

  • Conducts operational compliance reviews and audits trails to ensure defensible process practices.

  • Escalates high-risk revenue impacts with detailed analysis and mitigation strategies.

  • Represents Business Performance Optimization team on governance committees and operational workgroups.

  • Promotes a culture of transparency, accountability, and ethical process practices.

  • Complies with HIPAA and all regulatory, accreditation, and organizational policies.

  • Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

  • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as a resource to less experienced staff.

  • Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards of providing safe, caring, personalized and efficient experiences to patients and our workforce.

  • Other duties as assigned.