Revenue Cycle Consultant (Senior)

Tria Federal is seeking a highly motivated and skilled Revenue Cycle Consultant (Senior) to join our team. As a Revenue Cycle Consultant, you will provide professional consulting services to assist our Department of Defense client in managing enterprise revenue cycle and revenue integrity functions across Military Treatment Facilities (MTFs) and shared services. This includes reviewing and analyzing data, identifying process improvement opportunities, and developing recommendations to enhance efficiency and effectiveness front-end, mid-cycle, and back-end business processes (scheduling/registration, coding/charge capture, billing, denial management, reimbursement, and compliance).

Ideal candidate would have an active security clearance with the DHA.
**This job opportunity is contingent upon contract award.**

Responsibilities:

• Leads workstreams and serves as day-to-day client counterpart for revenue integrity and revenue cycle initiatives; provides subject-matter expertise on charge capture, coding quality, clinical documentation, CDM governance, claim edit resolution, and denial prevention.
• Demonstrates knowledge of the Defense Health Agency (DHA) and Military Health System (MHS) client organization, strategic goals, governance structure, and overall client environment.
• Identifies problems, develops solutions, and implements changes to ensure processes, procedures, and operations are aligned with client strategy, policy, and performance targets.
• Conducts research and analysis to identify market and other macro trends that impact client business operations, and shares knowledge both internally and externally, as appropriate.
• Demonstrates ability to effectively work independently and in a team environment.
• Works effectively with cross-functional teams, stakeholders, and team members to ensure that everyone is working towards the same goals and objectives.
• Actively participates within project team(s) and engages with team members to ensure project objectives and client needs are met. Provides support and guidance as needed to ensure quality work products.
• Adheres to all established project processes, procedures, and guidelines regarding resources and how to use them. Communicates with leadership regarding resource needs and communicates changes.
• Adheres to defined work plans while maintaining all established timelines and deliverable deadlines.
• Assists in developing effective internal and external presentations and skillfully helps to facilitate client and internal team meetings.
• Ability to meet internal and external deadlines by efficiently managing time, prioritizing tasks, and utilizing available resources.
• Accurately documents client communications and shares information with the project team.
• Maintains effective communication with client and project team members.
• Develops SOPs, playbooks, and training materials; supports change management and adoption across MTF stakeholders.
• Ensures compliance with DHA UBO policies, TRICARE/DoD billing guidance, HIPAA, and internal controls as applicable.

Required Skills & Experience:

• Experience: 7+ years in healthcare revenue cycle, with focus on revenue integrity and/or large-scale revenue cycle transformation; prior federal/DHA/MHS consulting experience strongly preferred.
• Formal Education: Bachelor’s degree required, Finance, Business Administration, Healthcare Administration or related field preferred. Master’s degree (MBA, MHA, MPH, or related) preferred.
• Knowledge and a working understanding of revenue cycle concepts, business processes, and/or operations within the healthcare industry (commercial or federal).
• Ability to apply principles and practices in revenue cycle management and revenue integrity, such as charge capture, coding, billing, reimbursement, denial management, and compliance.
• Ability to use various software applications and tools to perform revenue cycle and integrity functions, such as Electronic Health Record systems (Oracle/Cerner MHS GENESIS Patient Accounting Module (CPAM)), billing/claim solutions/systems (Electronic Claims Clearinghouse (SSI), 3M 360 Encompass Institutional & Professional Coding, Claim Scrubber Edits (Alpha ii), Dentrix Billing, Patient Statements/Letters (RevSpring)), and data analytics tools/repositories (Excel, Power BI, SAS, Tableau, HealtheAnalytics).
• Ability to analyze and interpret complex data, processes, and reports related to revenue cycle and integrity.
• Ability to identify and resolve related to revenue cycle and integrity.
• Ability to collaborate and communicate effectively with team members, clients, business partners, and other various stakeholders involved in revenue cycle and revenue integrity.
• Ability to succeed in a dynamic team environment and produce deliverables in tight timeframes.
• Excellent oral, written, and interpersonal skills.
• Microsoft Office proficiency (Excel, Word, PowerPoint).
• Access:
• Ideal candidate would have an active security clearance with the DHA.

Desired Skills & Experience:

• Experience within the Military Health System (MHS) environment and requisite knowledge of revenue cycle operations.
• Experience with the Oracle/Cerner Electronic Health Record (EHR), Patient Accounting Module (CPAM), HealtheAnalytics, ideally in the MHS environment.
• Knowledge of MHS billing and coding policies and regulations.