Managing Consultant - Coding and Middle Revenue Cycle - Healthcare
Berkeley Research Group · Remote · $120,000–$165,000 (stated in the posting)
We Do Consulting Differently
The Integrated Health Solutions (IHS) practice at Berkeley Research Group (BRG) provides end-to-end advisory support to healthcare providers, payers, investors, and other stakeholders navigating complex strategic, operational, financial, and clinical challenges. Led by seasoned healthcare executives, operators, and clinicians, IHS partners with organizations to drive sustainable performance improvement and long-term growth through strategic growth design, operating model transformation, AI and digital enablement, clinical quality and patient care optimization, and revenue strategy, helping clients build resilient, future-ready healthcare enterprises in an increasingly complex environment.
Our four core service offerings include:
- Business Transformation Advisory
- Margin & Operational Improvement
- Clinical & Quality Transformation
- AI & Digital Solutions
Margin & Operational Improvement drives measurable financial improvement by providing clients with comprehensive solutions designed to increase revenue, optimize costs, and achieve sustainable margin improvement. This division uses innovative approaches to transform operating models and deliver measurable, lasting results. Our team of operational leaders, business analysts, and experienced subject matter experts focuses on implementing solutions across the following areas:
- Workforce Productivity and Human Resources
- Supply Chain and Corporate Overhead Performance
- Revenue Cycle Effectiveness
- Managed Care, Revenue Integrity, and Pricing Strategies
- Ambulatory Operations and Physician Enterprise
Position Summary
We are currently seeking a Managing Consultant to join our Coding and Middle Revenue Cycle service line within our IHS practice. This position requires a highly motivated problem solver with strong analytical, organizational, project management, and client relationship skills. The ideal candidate will combine deep knowledge of healthcare coding and clinical documentation processes with demonstrated consulting, operational improvement, or transformation experience.
The Managing Consultant will lead and support qualitative and quantitative engagements focused on improving coding accuracy, compliance, productivity, timeliness, reimbursement, and financial performance. This individual will also support the continued expansion of BRG’s middle revenue cycle capabilities across coding, clinical documentation integrity, health information management, charge capture, revenue integrity, denials prevention, reimbursement, and related functions.
This position is not primarily a production coding or coding quality review role. The successful candidate must demonstrate experience applying coding and health information management expertise to consulting engagements, operational improvement initiatives, process redesign, financial analysis, technology enablement, or organizational transformation. The consultant must be extremely knowledge and current on coding regulations and be able to provide and support positions related to coding outcomes and decisions for across specialty practices.
Travel Requirements
Willing to travel consistently (50%–80%), depending on project requirements and client expectations, is required for this position.
Responsibilities
- Plan and manage small- to medium-sized coding and middle revenue cycle engagements and workstreams within larger, multidisciplinary projects.
- Lead assessments of coding, clinical documentation integrity, health information management, and related middle revenue cycle operations.
- Develop project charters, work plans, staffing and budget plans, schedules, risk registers, client deliverables, and benefit realization models.
- Manage project teams, delegate work, review analyses and deliverables, and monitor scope, staffing, budgets, timelines, and engagement performance.
- Identify operational, financial, compliance, workforce, and technology opportunities; develop prioritized recommendations and implementation roadmaps.
- Present findings, recommendations, project progress, risks, and financial results to client leaders.
- Assess inpatient, outpatient, professional fee, and ambulatory coding for accuracy, compliance, productivity, timeliness, reimbursement, and financial performance.
- Evaluate coding workflows, staffing models, organizational structures, productivity standards, quality programs, management reporting, and performance management practices.
- Assess health information management workflows, including chart completion, record integrity, coding queues, discharged-not-final-billed management, and physician query processes.
- Evaluate clinical documentation integrity processes and their integration with coding, utilization management, quality, revenue integrity, and denials prevention.
- Assess governance for coding and clinical documentation integrity, including accountabilities, escalations, performance standards, and committees.
- Analyze coding-related denials, clinical validation issues, claim edits, and payment variances; identify root causes and recommend preventive and corrective actions.
- Quantify the effects of coding backlogs, documentation deficiencies, incomplete records, late charges, and other middle revenue cycle breakdowns.
- Evaluate coding audit and quality assurance programs, including sampling, accuracy standards, education, corrective actions, and monitoring.
- Assess internal, outsourced, and hybrid coding models, including vendor performance, service levels, quality controls, capacity, productivity, and cost.
- Review and improve coding, clinical documentation integrity, and health information management policies and procedures in line with applicable requirements.
- Design and support implementation of future-state operating models, governance, workflows, policies, controls, performance standards, and monitoring tools.
- Analyze coding, documentation, billing, claims, denials, workforce, and financial data to identify trends and quantify improvement opportunities.
- Develop financial and benefit realization models for coding accuracy, documentation, staffing, productivity, reimbursement, and denials prevention initiatives.
- Build dashboards, key performance indicators, management reports, and monitoring frameworks to track financial, operational, quality, and compliance results.
- Evaluate coding accuracy and productivity, turnaround time, discharged-not-final-billed days, query response, case mix, severity capture, denials, and vendor performance.
- Translate coding and documentation findings into clear financial, operational, compliance, and strategic implications for client leadership.
- Assess coding, clinical documentation integrity, health information management, computer-assisted coding, encoder, workflow, analytics, and revenue cycle systems.
- Evaluate automation, natural language processing, and AI-enabled workflows for coding efficiency, documentation quality, work prioritization, audit, and denials prevention.
- Support technology selection, implementation planning, workflow design, testing, adoption, training, and performance monitoring.
- Assess computer-assisted and autonomous coding capabilities, including exception management, accuracy monitoring, compliance controls, and workforce implications.
- Coordinate with client technology, revenue cycle, clinical, compliance, finance, and operations teams to align solutions with organizational priorities.
- Build relationships with client executives and coding, health information management, clinical, compliance, and finance leaders.
- Collaborate across BRG’s coding, documentation, revenue integrity, patient financial services, managed care, analytics, digital, and operations teams.
- Develop methods, analytical tools, benchmarks, implementation playbooks, templates, and supporting documentation.
- Support proposals, engagement scoping, pursuit presentations, client relationships, and identification of follow-on opportunities.
- Contribute to relevant articles, white papers, presentations, training, and other thought leadership.
- Coach junior professionals through feedback, development support, and appropriately delegated responsibility.
Qualifications
- Five or more years of healthcare consulting or industry experience in coding, health information management, clinical documentation integrity, or related middle revenue cycle functions is required. Previous experience within a consulting environment is highly preferred.
- A bachelor’s or master’s degree, such as a BS, BBA, MBA, MHA, MA, or MS, preferably in health information management, healthcare administration, business administration, finance, accounting, nursing, or a related discipline, is required.
- An active RHIA, RHIT, CCS, CCS-P, CPC, CIC, COC, or comparable coding or health information management credential is required.
- Demonstrated consulting, performance improvement, process redesign, organizational transformation, or implementation experience in coding or the middle revenue cycle is required.
- Experience applying coding or health information management expertise beyond production coding or routine coding quality review is required.
- Experience leading assessments and implementation initiatives, managing concurrent workstreams, and delivering projects within scope, budget, and schedule expectations is required.
- Experience leading project teams, mentoring junior professionals, delegating assignments, and reviewing work products is required.
- Operational expertise in one or more of facility inpatient, facility outpatient, professional fee or ambulatory coding; health information management; clinical documentation integrity; computer-assisted or autonomous coding; coding quality and compliance; coding-related denials; discharged-not-final-billed management; or charge capture and revenue integrity is required.
- Current working knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, modifiers, and applicable official coding guidelines is required.
- Working knowledge of Medicare IPPS, OPPS, professional fee, and ambulatory reimbursement methodologies and their relationship to coding, documentation, billing, and payment is required.
- Knowledge of MS-DRG and APC assignment, severity capture, risk adjustment, and the financial and quality effects of coding and documentation practices is required.
- Experience assessing coding productivity, quality, turnaround time, staffing capacity, organizational structure, vendor performance, and management oversight is required.
- Familiarity with coding-related denials, clinical validation, medical necessity, claim edits, and payment variance root-cause analysis is required.
- Working knowledge of regulatory and compliance requirements affecting coding, documentation, billing, reimbursement, and health information management is required.
- Experience analyzing large healthcare datasets and turning findings into financial, operational, and compliance recommendations is required.
- Strong written, verbal, and presentation skills, including the ability to communicate technical findings to executive, clinical, operational, financial, and compliance audiences, are required.
- Ability to lead client meetings, facilitate stakeholder discussions, and build agreement around recommended changes is required.
- Ability to balance coding requirements with operational feasibility, financial impact, compliance risk, and organizational priorities is required.
- Ability to manage multiple responsibilities, workstreams, and deadlines in a consulting environment is required.
- Advanced proficiency in Microsoft Excel and PowerPoint, and proficiency in Word and Outlook, are required.
- Familiarity with electronic health record, patient accounting, encoder, computer-assisted coding, clinical documentation integrity, health information management, and revenue cycle systems is required.
- Additional credentials in clinical documentation integrity, coding audit, data analytics, project management, process improvement, or revenue cycle management, such as CCDS, CDIP, CPMA, CHDA, PMP, Lean Six Sigma, CHFP, or CRCR, are preferred.
Salary Range: $120,000 - $165,000 per year
Job title and compensation to be determined based on qualifications and experience.
Candidate must be able to submit verification of legal right to work in the U.S., without company sponsorship.
About BRG
BRG combines world-leading academic credentials with world-tested business expertise and purpose-built emerging technologies. Our culture centers on agility and connectivity which sets us apart and gets you ahead.
At BRG, our professionals include specialist consultants, industry experts, renowned academics, and leading-edge data scientists. Together, they bring a diversity of real-world experience, data, and human and artificial intelligence, to economics, disputes, and investigations; corporate finance; and performance improvement services that address the most complex challenges facing organizations across the globe.
Our unique structure nurtures the interdisciplinary relationships that give us the edge, laying the groundwork for more informed insights and more original, incisive thinking. When paired with our global reach and resources, our diverse perspectives and technical capabilities make us uniquely capable to address our clients’ challenges. We get results because we know how to apply our thinking to your world.
At BRG, we don’t just show you what’s possible. We’re built to help you make it happen.
BRG is proud to be an Equal Opportunity Employer. Our hiring practices provide equal opportunity for employment without regard to race, religion, color, sex, gender, national origin, age, United States military veteran status, ancestry, sexual orientation, marital status, family structure, medical condition including genetic characteristics or information, veteran status, or mental or physical disability so long as the essential functions of the job can be performed with or without reasonable accommodation, or any other protected category under federal, state, or local law.