Plante Moran
Senior Consultant- Revenue Cycle Management
Plante Moran, Chicago, Illinois, United States, 60290
Overview
Count on us.
Our "we-care" culture is more than just a motto; it's a promise. From day one, we prioritize your growth, well-being, and success. You can count on us to support your career journey and help you achieve your professional goals. Join us. Your role
We are seeking an experienced Senior Consultant specializing in middle revenue cycle functions to join our dynamic team. The ideal candidate will have a strong background in charge validation, coding, Clinical Documentation Improvement (CDI), medical necessity verification, and denials management. This role requires a deep understanding of healthcare revenue cycle processes and the ability to provide strategic guidance to optimize revenue integrity and compliance. Responsibilities
Conduct thorough reviews of charge capture processes to ensure accuracy and compliance with regulatory standards. Identify and rectify discrepancies in charge entries to prevent revenue leakage. Collaborate with clinical departments to enhance charge capture accuracy. Provide guidance to clients on coding processes to ensure adherence to ICD-10, CPT, and HCPCS coding guidelines. Perform regular audits to identify and correct coding errors. Lead CDI initiatives to improve the quality and completeness of clinical documentation. Work closely with physicians and clinical staff to ensure documentation accurately reflects the patient\'s clinical status and care provided. Implement CDI best practices and monitor their effectiveness. Review and verify the medical necessity of services provided to ensure compliance with payer requirements. Develop and implement processes to streamline medical necessity verification. Educate clinical staff on documentation requirements for medical necessity. Analyze and manage denials to identify root causes and implement corrective actions. Develop strategies to reduce denial rates and improve the appeals process. Collaborate with payers to resolve complex denial issues. Provide expert consulting services to clients, offering strategic recommendations to optimize their revenue cycle processes. Develop and maintain strong client relationships, ensuring high levels of client satisfaction. Prepare and present detailed reports and analyses to clients and senior management. Qualifications
Bachelor\'s degree in Business, Healthcare Administration, or a related field. Master\'s degree preferred. Minimum of 7 years of experience in revenue cycle management, with a focus on middle revenue cycle functions. Prior experience at a reputable RCM consulting firm is highly desirable. Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification preferred. Strong knowledge of healthcare regulations, including HIPAA, CMS guidelines, and payer policies. Excellent analytical, problem-solving, and communication skills. Ability to work independently and as part of a team in a fast-paced environment. Proficiency in using RCM software and tools. What makes us different?
On the surface, we\'re one of the nation\'s largest audit, tax, consulting, and wealth management firms. We strive for a respectful, inclusive culture with recognition as one of Fortune Magazine\'s "100 Best Companies to Work For." Plante Moran is an Equal Opportunity Employer and maintains a drug-free workplace. Interested applicants must submit their resume using our applicant tracking system. Due to high volume of interest, only candidates selected for interviews will be contacted. Applicants must be legally authorized to work in the United States without sponsorship, with exceptions for bilingual candidates. Unsolicited resumes from search firms or agencies will not be paid a fee and become the property of Plante Moran. Colorado & Illinois Applicants: Compensation is commensurate with experience. Benefits vary by location; details provided during the hiring process. Colorado and Illinois ranges: $7,750 - $9,583.33 monthly base.
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Count on us.
Our "we-care" culture is more than just a motto; it's a promise. From day one, we prioritize your growth, well-being, and success. You can count on us to support your career journey and help you achieve your professional goals. Join us. Your role
We are seeking an experienced Senior Consultant specializing in middle revenue cycle functions to join our dynamic team. The ideal candidate will have a strong background in charge validation, coding, Clinical Documentation Improvement (CDI), medical necessity verification, and denials management. This role requires a deep understanding of healthcare revenue cycle processes and the ability to provide strategic guidance to optimize revenue integrity and compliance. Responsibilities
Conduct thorough reviews of charge capture processes to ensure accuracy and compliance with regulatory standards. Identify and rectify discrepancies in charge entries to prevent revenue leakage. Collaborate with clinical departments to enhance charge capture accuracy. Provide guidance to clients on coding processes to ensure adherence to ICD-10, CPT, and HCPCS coding guidelines. Perform regular audits to identify and correct coding errors. Lead CDI initiatives to improve the quality and completeness of clinical documentation. Work closely with physicians and clinical staff to ensure documentation accurately reflects the patient\'s clinical status and care provided. Implement CDI best practices and monitor their effectiveness. Review and verify the medical necessity of services provided to ensure compliance with payer requirements. Develop and implement processes to streamline medical necessity verification. Educate clinical staff on documentation requirements for medical necessity. Analyze and manage denials to identify root causes and implement corrective actions. Develop strategies to reduce denial rates and improve the appeals process. Collaborate with payers to resolve complex denial issues. Provide expert consulting services to clients, offering strategic recommendations to optimize their revenue cycle processes. Develop and maintain strong client relationships, ensuring high levels of client satisfaction. Prepare and present detailed reports and analyses to clients and senior management. Qualifications
Bachelor\'s degree in Business, Healthcare Administration, or a related field. Master\'s degree preferred. Minimum of 7 years of experience in revenue cycle management, with a focus on middle revenue cycle functions. Prior experience at a reputable RCM consulting firm is highly desirable. Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification preferred. Strong knowledge of healthcare regulations, including HIPAA, CMS guidelines, and payer policies. Excellent analytical, problem-solving, and communication skills. Ability to work independently and as part of a team in a fast-paced environment. Proficiency in using RCM software and tools. What makes us different?
On the surface, we\'re one of the nation\'s largest audit, tax, consulting, and wealth management firms. We strive for a respectful, inclusive culture with recognition as one of Fortune Magazine\'s "100 Best Companies to Work For." Plante Moran is an Equal Opportunity Employer and maintains a drug-free workplace. Interested applicants must submit their resume using our applicant tracking system. Due to high volume of interest, only candidates selected for interviews will be contacted. Applicants must be legally authorized to work in the United States without sponsorship, with exceptions for bilingual candidates. Unsolicited resumes from search firms or agencies will not be paid a fee and become the property of Plante Moran. Colorado & Illinois Applicants: Compensation is commensurate with experience. Benefits vary by location; details provided during the hiring process. Colorado and Illinois ranges: $7,750 - $9,583.33 monthly base.
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