Consultant, Coding & Revenue Integrity

• Serve as the primary coding subject matter expert for both client and internal coding teams, providing hands-on leadership and guidance to support effective execution and outcomes.
• Provide real-time support for complex coding questions and escalations.
• Partner with client leadership to ensure coding operations align with organizational goals.
• Establish, monitor, and report on coding KPIs, including:
• DNFB
• Coding accuracy
• Productivity
• Denial rates tied to coding
• Drive accountability for performance and outcomes across coding teams.
• Proactively identify missed or under-realized revenue opportunities, including:
• Missed charges
• Incorrect coding
• Documentation gaps

• Workflow inefficiencies

• Quantify financial impact of each opportunity and present findings to leadership.
• Develop and implement actionable recommendations to capture additional revenue.
• Partner with chargemaster, clinical, and billing teams to ensure proper revenue capture.
• Design and deliver targeted training programs for client and Tegria staff, including:
• Coding updates and regulatory changes
• Documentation improvement

• Complex workflows (denials, medical necessity, charge capture)

• Provide hands-on coaching and mentorship to coding staff.

• Simplify and standardize workflows to improve efficiency and reduce errors.

• Advise clients on new service line implementation, including:
• Coding and billing requirements
• Pricing strategy and reimbursement modeling
• CMS and Medicaid regulatory guidance
• Evaluate operational readiness and identify risks prior to go-live.
• Ensure alignment between clinical operations, coding, and billing workflows.
• Partner with billing teams to analyze denial trends and identify coding-related issues.
• Perform root cause analysis on denials tied to coding and documentation.
• Develop and implement corrective action plans to prevent recurrence.
• Track and report measurable improvements in denial rates and cash collections.
• Serve as the primary coding and revenue integrity advisor to client executive teams.
• Communicate:
• Key risks
• Performance trends
• Revenue opportunities
• Strategic recommendations
• Present data in a way that ties coding performance directly to cash and financial outcomes.
• Build strong client relationships based on trust, expertise, and results.
• Perform targeted coding activities to:
• Validate accuracy
• Identify workflow breakdowns
• Uncover revenue opportunities
• Avoid routine production coding; focus on high-impact analysis and problem-solving.

Do you have experience in Workflow management (operations management method)?, Do you have a Associate’s degree?, * Associate’s degree in health information management, Healthcare Administration, or a related field, or equivalent combination of education and experience.

• CPC, CCS, RHIT, or RHIA certification required
• Typically, 5+ years of advanced coding experience across multiple service lines.
• Proven experience in:
• Denial analysis
• Revenue optimization
• Training and education
• Client-facing consulting
• Experience with EHR systems such as MEDITECH, Epic, or similar
• Strong understanding of end-to-end revenue cycle operations
• Expert knowledge of charge capture, coding guidelines, compliance requirements, and documentation standards.
• Broad understanding of coding across service lines, including hospital, professional, and ancillary services.
• Understanding of how coding impacts downstream billing, denials, AR, and reimbursement.
• Works successfully under general direction and with wide latitude for independent judgment.
• Proficiently use Office Productivity and Collaboration Tools (e.g., O365).
• Work comfortably within EHR systems and reporting tools.
• Proactively identify opportunities for improvement.
• Maintain high standards of quality and commitment to integrity and compliance.
• Translate coding insights into financial impact

Pulled from the full job description

• AD&D insurance
• 401(k)
• Vision insurance
• Dental insurance
• Employee assistance program