Revenue Cycle Optimization Consultant

📋 Description

• • TruBridge is seeking a highly skilled and experienced Revenue Cycle Optimization Consultant to join our dynamic team. In this critical role, you will be instrumental in the comprehensive review, strategic development, and continuous enhancement of the Charge Description Master (CDM) for our diverse portfolio of clients across the United States. Your expertise will ensure that each client's CDM remains compliant with all federal and state regulations, thereby optimizing charge capture processes and maximizing reimbursement.
• • You will act as a pivotal subject matter expert (SME) in CDM strategy, guiding clients and internal teams towards consistent, compliant, and efficient practices. This involves not only maintaining the current state of the CDM but also proactively identifying opportunities for significant improvements in both reimbursement and overall operational efficiency. The insights and solutions you develop will be leveraged for ongoing client reviews and can also be offered as specialized external services, generating additional value for our clients and TruBridge.
• • A core responsibility will be the meticulous performance of CDM reviews and ongoing maintenance. This includes ensuring the CDM is updated promptly and accurately, reflecting the latest CMS quarterly updates and other regulatory changes. You will be responsible for obtaining and integrating quarterly update files into the tools used for chargemaster reviews, ensuring the integrity and currency of the data.
• • Collaboration is key to success in this role. You will work closely with various internal departments, including Revenue Cycle, Compliance, Clinical Leadership, Finance, and IT, as well as client-side stakeholders. This cross-functional teamwork is essential for standardizing CDM practices across the board and ensuring alignment with enterprise-wide goals and client objectives.
• • You will stay continuously informed about the latest industry changes, particularly quarterly OPPS (Outpatient Prospective Payment System) changes as published by CMS. This proactive approach ensures that client CDMs are always aligned with current payment regulations and guidelines.
• • A significant part of your role will involve supporting annual chargemaster updates for clients, driven by changes in CMS, AMA, and other payer regulations. This includes updating CPT/HCPCS codes, revenue codes, and ensuring adherence to all relevant billing rules.
• • You will engage directly with clients, conducting meetings to discuss identified worklist items requiring correction and diligently following up to ensure these corrections are implemented effectively. This client-facing aspect requires strong communication and problem-solving skills.
• • A crucial element of this consultancy is client education. You will be responsible for educating clients on best practices for chargemaster maintenance, especially when they are introducing new charge items. This includes providing expert guidance on identifying appropriate HCPCS codes, revenue codes, and developing effective rate-setting strategies, potentially utilizing various analytical tools.
• • Leveraging datamining techniques, you will identify clients experiencing high rates of original errors or denials attributed to item master inaccuracies. For these clients, you will conduct in-depth chargemaster reviews, providing actionable recommendations to enhance their clean claim rates and significantly reduce denial occurrences.
• • You will collaborate closely with Compliance, TBEHR Financial Support, RCM (Revenue Cycle Management), and CBO (Centralized Billing Office) teams to propose necessary RCM edits, develop client education materials, and update company documentation as needed, ensuring a cohesive and informed approach to revenue cycle management.
• • Establishing and diligently monitoring Key Performance Indicators (KPIs), reporting dashboards, and operational benchmarks will be vital for tracking and demonstrating CDM performance improvements.
• • You will play a key role in supporting pricing transparency initiatives, ensuring compliance with chargemaster publication requirements, and adhering to the No Surprises Act and related legislation as it pertains to the chargemaster.
• • Furthermore, you will lead the CDM function during significant organizational or client-side initiatives, such as EHR transitions, mergers, acquisitions, or the launch of new service programs, ensuring seamless integration and continued compliance.
• • This role is designed for an individual contributor who thrives on complex problem-solving and driving tangible results within the healthcare revenue cycle space.