Tria Federal is hiring a
Revenue Cycle CDM Consultant

Summary

Tria Federal is seeking a highly experienced Revenue Cycle CDM Consultant (Senior) to join their team. The role involves assisting a Department of Defense client in managing operational and revenue cycle operations. The candidate should have at least 7+ years of experience, knowledge of revenue cycle concepts, business processes, and/or operations within the healthcare industry, and proficiency in Microsoft Office.

Requirements

• Knowledge and a working understanding of revenue cycle concepts, business processes, and/or operations within the healthcare industry (commercial or federal)
• Knowledge and understanding of basic coding/billing requirements and charge master/pricing database design and configuration to include CPT/HCPCS codes, ICD-10 diagnosis and procedure codes, revenue codes, and modifiers
• 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 revenue cycle and integrity
• Ability to identify and resolve issues and problems 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)

Responsibilities

• Demonstrates knowledge of the 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’s business operations
• 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
• Monitors and advises on the latest healthcare coding and billing updates and changes in accordance with Medicare reimbursement or commercial healthcare industry reimbursement and claim submission guidelines
• 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
• Maintains effective communication with client and project team members

Preferred Qualifications

• Experience within the Military Health System (MHS) environment and requisite knowledge of revenue cycle operations
• Knowledge of MHS billing and coding policies and regulations
• Experience with the Oracle/Cerner Electronic Health Record (EHR), Patient Accounting Module (CPAM), Health Analytics, ideally in the MHS environment
• Experience with designing, implementing, or maintaining a charge master, ideally using Oracle/Cerner and Charge Services tools and applications: CSPricingTool