Revenue Optimization Consultant 1

Revenue Optimization Consultant

The Revenue Optimization Consultant supports enterprise initiatives to improve charge capture performance and optimize net revenue through analysis, coordination, and implementation of targeted improvement efforts. Working in collaboration with other Revenue Cycle teams, this role helps strengthen Charge Description Master (CDM) accuracy and charge capture processes through structured project management, workflow optimization, and performance monitoring.

This is a hybrid position: Onsite twice per year. Candidate will work Central Time Zone hours 8am - 5pm.

Responsibilities include:

• Revenue Optimization: Supports CDM and revenue capture related optimization efforts that improve charge accuracy and protect net revenue across hospitals, clinics, and employed medical groups.
• Denials Prevention: Reviews charging- and CDM-related denials, identifies root causes, develops and recommends corrective actions, and collaborates with Revenue Cycle teams on implementation.
• Late Charges & Avoidable Write-offs (AWOs): Supports development of processes to monitor and investigate late charges and charging-related AWOs and mitigate recurrence.
• Revenue Leakage Detection: Uses data analysis and reporting to identify missed charging opportunities and support process improvements that reduce revenue leakage.
• Go-Live Support: Provides project management support in collaboration with other Revenue Cycle teams, for CDM and charging-related activities associated with new hospitals, clinics, service lines, and major enterprise initiatives.
• Charge Edit Optimization: Reviews charge edits and work queue accuracy, consistency, and efficiency; identifies root causes of recurring errors; and partners with stakeholders to implement sustainable process and system improvements.
• Technology Enablement: Identifies new technology and automation that enhances and supports timely and accurate charging. Conducts vendor reviews and ROI analysis and provides recommendations to senior revenue cycle leadership. Stays abreast of Epic roadmap to identify current and upcoming capabilities that strengthen charging related processes.
• Performance Reporting: Monitors revenue-related reporting and metrics to monitor outcomes, identify trends, and prioritize optimization work.
• Stakeholder Communication: Communicates findings, progress, and recommendations clearly to Revenue Cycle partners and operational stakeholders to support informed decision-making and follow-through.
• All Other Duties: Performs other position-appropriate duties as required in a competent, professional, and courteous manner.

Key success factors include:

• Strong verbal and written communication skills, including the ability to clearly summarize issues, findings, and recommendations for Revenue Cycle and operational stakeholders.
• Ability to manage multiple priorities simultaneously and execute assigned work with accuracy, organization, and appropriate follow-through in a fast-paced environment.
• Strong analytical and problem-solving skills, with the ability to review data, audit charge accuracy, identify trends, determine root cause, and support practical, sustainable solutions.
• Ability to work independently and collaboratively, while proactively identifying issues, escalating concerns appropriately, and contributing to cross-functional improvement efforts.
• Advanced knowledge of Excel and data analytics to include formulas, functions, and pivot tables in order to analyze large data sets, draw conclusions, and translate findings into actionable insights.
• Adept in researching complex questions, providing recommendations, making decisions, and devising strategies to result in appropriate outcomes.
• Knowledge of healthcare revenue cycle operations, including charging, billing, reimbursement, and denial prevention principles.
• Strong organizational skills and attention to detail, including the ability to maintain accurate documentation, manage issue tracking, and support implementation of process improvements.
• Maintains knowledge of CDM management and denials mitigation, along with comprehensive knowledge of healthcare billing, finance, and reimbursement.

Qualifications:

• Education - Bachelor's or 4 years of work experience above the minimum qualification
• Experience - 3 Years of Experience

Preferred Qualifications:

• Bachelor's degree required. Bachelor's degree in business, finance, healthcare administration, or related field preferred.
• Master's degree preferred.
• 3+ years of experience in healthcare revenue cycle, revenue optimization, or related functions.
• Experience in a large, complex integrated health system preferred.
• Epic Hospital Billing, Professional Billing, and Chargemaster experience preferred.
• Experience evaluating denials to identify root cause preferred.