Revenue Integrity Consultant, Bus. Performance Optimization (Hybrid)

Job description

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team. Job Summary This position is responsible for driving operational efficiency, performance optimization, and strategic transformation across healthcare revenue cycle functions through expert business performance optimization (BPO) consulting. The BPO Consultant serves as a cross-functional liaison supporting initiatives in workflow redesign, automation, continuous process improvement projects, EHR and billing system optimization, and KPI development. This role supports hospital and physician enterprise operations by leading value stream assessments, developing standardized workflows, and enabling scalable solutions through technology and data-driven decision-making. The consultant partners with IT, Finance, Operations, and Compliance teams to enhance transparency, accuracy, and long-term sustainability of revenue and compliance performance. Typically reports to the Director, Professional Revenue Integrity. Job Description Minimum Qualifications 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 preferred: Certified Professional Coder (CPC), or Certified Coding Specialist (CCS), or Certified Professional Biller (CPB) 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.