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Revenue Integrity / RN Senior Consultant

Office Location:Homebased – US

Lets transform the business of healthcare! At The Craneware Group, we are dedicated to empowering our customers with industry-defining insights that pave the way for a brighter future.

If you are an energetic, forward-thinking inidual with a passion for innovation, we invite you to join our thriving team of more than 750 dedicated professionals. Together, we’ll fuel the expansion of our SaaS platform and develop cutting-edge applications that redefine the healthcare landscape.

The Team

At The Craneware Group, we have a talented mix of employees from erse backgrounds, which brings a high level of innovation and collaboration to deliver excellent customer service. We are currently seeking an experiencedRevenue Integrity/Registered Nurse Senior Consultantto join our team. We are seeking an RN with Revenue Integrity Experience who is AAPC certified, with 3 5 years of experience in claims auditing and appeals writing.

Come join a seasoned team of Clinical Revenue Integrity industry experts. If you are looking for a fast-paced position where you can apply your clinical and revenue integrity skills, while driving project from end to end, this may be the perfect position for you. This position allows you to be innovative along with your colleagues to support Customers from a Clinical Revenue Integrity perspective.

You Will Be

• Assessing andanalyzingServices offerings provided by Consulting; Document Best Practice;DriveContinuous Process Improvement.
• Acting as a resource/go-to person for TCG key stakeholders (i.e., Product Management, Development, Sales, Customer facing teams).
• Providingmastery level consulting to hospitals seeking insights and guidance to ensure best practices.
• Servingas a Project Manager to oversee the daily operations of the specific services provided to ensure best practices.
• Completingrevenue cycle assessments by reviewing current operations and conducting key interviews to identify opportunities for improvement.
• Performing comprehensive assessments of charge capture and reconciliation procedures to ensure all services provided are charged.
• Assessing charge ticket and interface mappings to the CDM to identify discrepancies.
• Testing claim logic within billing and scrubber systems to ensure accurate flow of coded data to the bill and to the payor.
• Conducting CDM reviews to assure all lines are coded correctly and all services rendered are available to charge.
• Conducting audits to assess the accuracy and completeness of the bills, coding, medical record documentation, and/or level of care assignment to ensure regulatory compliance and maximize revenue opportunities.
• Reviewing medical records and utilize clinical knowledge and regulatory guidance as well as knowledge of payer requirements to determine reasons for denial and whether an appeal is warranted.

You Will Bring

• Educated toBachelorDegreelevel
• RN, BSN, CPC, COC or CCS certification
• 7+ years experience in specific services provided and healthcare operations
• 5 years experience managing project teams
• In-depth knowledge and understanding of healthcare services, health information technology, regulatory requirements, clinical data management, project management
• Exceptional communication skills both written and verbal
• Dedication to staying current with industry changes and advances
• 5+ years experience working with commonly used financial systems and transaction processing systems such as EPIC, McKesson, Cerner, Meditech, Paragon, CPSI, GE, and Siemens
• Proficiency with Microsoft Office and associated TCG products
• Research and analysis skills
• Demonstrates a high level of commitment to superior customer satisfaction through the entire duration of the customer relationship.
• Highly accountable and results oriented, burning desire to get things done and a sense of urgency, resourceful with excellent planning skills
• AAPCCertification with 3-5 yearsexperiencein claims auditingand appealswriting

AAPC Certification with 3-5 years experience