Senior Consultant- Revenue Cycle Management

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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.

Key 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. But dig a little deeper, and you'll see what makes us different : we're a relatively jerk-free firm (hey, nobody 's perfect) with a world-class culture, consistent recognition as one of Fortune Magazine's "100 Best Companies to Work For," and an endless array of opportunities.At Plante Moran, diversity, equity and inclusion means that all staff members have equitable and fair opportunities to succeed, in an inclusive environment, with their individual, unique identities. So,what are you waiting for? Apply now.

Plante Moran enjoys a "Workplace for Your Day" model which, simply put, means we strive for flexibility and balance while staying true to our principally in-person model. We believe that face-to-face interactions are paramount for individual and collective development, but also encourage individuals to work with their supervisor and team to determine their optimal working environment each day.

Plante Moran is committed to a diverse workplace.We strive to create a culture where each person feels accepted and valued. We believe that each person's ultimate potential begins with first acknowledging their inherent dignity. When we can recognize - and celebrate - our many human differences, we're able to create a workplace where all staff feel a sense of belonging and an opportunity to succeed. This allows us to attract and retain the best talent, serve clients through diverse thinking, and better represent and support the various communities in which we live and work.Plante Moran is an Equal Opportunity Employer.

Plante Moran maintains a drug-free workplace.

Interestedapplicantsmust submit their resume for consideration using our applicant tracking system. Due to the high volume of interest in our positions, only candidates selected for interviews will be contacted. Candidates must be legally authorized to work in the United States without sponsorship, with the exception of qualified candidates who are bilingual in either Japanese and English or Chinese and English. Unsolicited resumes from search firms or employment agencies, or similar, will not be paid a fee and become the property of Plante Moran.

The specific statements above are not intended to be all-inclusive.

For Colorado & Illinois Applicants :

We are pleased to offer eligible staff a robust benefits package. Eligibility and contribution requirements for some of these benefits vary based on the number of hours staff work per week. Highlights include health, dental, vision, disability and life insurance. These standard offerings are effective on the first of the month following your start date. In addition to this, eligible staff are able to take advantage of our Flexible Time Off and various pre-determined holidays as well as a 401(k) plan, flexible benefits plans, business-related travel expense, lodging and meal reimbursement for business-related use. A Pension plan is also available for eligible administrative and paraprofessional staff. A discretionary bonus plan is available for eligible staff. Plante Moran also offers Interns and Contractors the option to elect health insurance under our contingent staff medical plan as of the 1st of the month following 60 days of employment in addition to limited paid time sick time. Seasonal staff are not eligible for benefits.

Compensation is commensurate with technical skills and experience is provided in accordance with applicable state requirement. Compensation information posted is based on a position being located in the state of CO or IL. Please review theposition location for theapplicable geographic location.

Under Colorado's Job Application Fairness Act, you have the right to redact from any documents that you submit in connection with your application information that identifies your age, date of birth, or dates of attendance at or graduation from an educational institution. Should you wish to exercise your right to redact such information, please redact it prior to submitting documentation.

Colorado monthly base range is as follows : $ 7,750-9,583.33

Illinois monthly base range is as follows : $ 7,750-9,583.33

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