Memorial Hermann Health System · 2 months ago
Business Performance Optimization Revenue Integrity Consultant (Hybrid)
Medical Plaza North
Full-time
Hybrid
Senior Level
5+ years expMemorial Hermann Health System is dedicated to delivering high quality, efficient care while creating exceptional experiences for the community. The Business Performance Optimization Revenue Integrity Consultant is responsible for driving operational efficiency and performance optimization across healthcare revenue cycle functions, serving as a cross-functional liaison to support workflow redesign, automation, and continuous process improvement.
Health CareNon Profit
Responsibilities
Evaluates workflows and system configuration for missing, late, or duplicate workflow and processes
Performs root cause analysis on workflow and process discrepancies and coordinates workflow and process reconciliation
Recommends and implements workflow and documentation improvements to prevent leakage
Collaborates with pricing and process architecture teams on annual price reviews, updates, and payer impact modeling
Consults on workflow and process code additions, deletions, and revisions based on service line expansion or reimbursement updates
Supports pricing strategies that maintain operational compliance and competitiveness
Collaborates and uses data reporting resources to develop reports, dashboards, and variance analyses using Epic
Interprets trends in revenue capture, claim process breakdowns or gaps, denial overturns, workflow and process lag, and payer mix shifts
Provides actionable recommendations with measurable outcomes to clinical and finance stakeholders
Identifies improper coding/documentation contributing to revenue variances
Collaborates with coding, HIM, and operational compliance departments to ensure workflow and process and code integrity
Assists with payer denial resolution strategy and monitors audit outcomes (internal and external)
Leads consulting engagements with operational and clinical teams on new initiatives (e.g., service expansion, provider onboarding, payer policy updates)
Provides subject matter expertise during system implementations and upgrades, including Epic optimization
Tracks milestones, defines KPIs, mitigates risks, and ensures post-implementation sustainability
Provides training to department stakeholders on workflow and process policies, documentation expectations, Epic functionality, and revenue integrity standards
Acts as a liaison between IT, Coding, Compliance, and Operational leaders to ensure aligned goals and effective communication
Educates on current process and charging regulations, including No Surprises Act (NSA), GFE, and regulatory updates
Supports continuous improvement projects across workflow and process review, process breakdowns or gaps management, and reimbursement accuracy
Conducts operational compliance reviews and audits trails to ensure defensible process practices
Escalates high-risk revenue impacts with detailed analysis and mitigation strategies
Represents Business Performance Optimization team on governance committees and operational workgroups
Promotes a culture of transparency, accountability, and ethical process practices
Complies with HIPAA and all regulatory, accreditation, and organizational policies
Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service
Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as a resource to less experienced staff
Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards of providing safe, caring, personalized and efficient experiences to patients and our workforce
Other duties as assigned
Qualification
Required
Revenue Integrity experience
Extensive Revenue Cycle experience ranging from front-end to back-end
Manager or director level experience in Revenue Cycle
Excellent problem solving skills
Able to interact with individuals at all levels
Comfortable with presenting to executive level leaders
Epic experience
Associate's degree in Healthcare Administration, Finance, Business, Nursing, or related field, or In lieu of Associate's degree, two (2) additional years of experience is required, for a total of seven (7) years of progressive experience in Revenue Cycle required
Five (5) years of progressive experience in Revenue Cycle required; experience in a consulting, analytics, or hospital system environment preferred
Extensive knowledge of CPT/HCPCS/ICD-10, CMS process rules, payer reimbursement strategies, and workflow and process methodologies (DRG, APC, OPPS)
Proficient in Epic (one or more Epic modules, especially Epic workflow and WQs), Microsoft Excel (pivot tables, formulas), and reporting tools (i.e. Tableau, Power BI, or SQL)
Strong written and verbal communication and experience presenting to executive audiences
Proven success driving multi-stakeholder initiatives and optimizing revenue capture processes
Ability to lead complex assessments, manage projects, and influence cross-functional teams
Preferred
Certified Revenue Cycle Representative (CRCR)
Certified Healthcare Revenue Integrity (CHRI)
Project Management Professional (PMP)
Certified Lean Six Sigma
Company
Memorial Hermann Health System
Advancing Health. Personalizing Care.
10001+ employees
H1B Sponsorship
Memorial Hermann Health System has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (10)
2024 (6)
2023 (11)
2022 (6)
2020 (3)
Funding
Current Stage
Late StageTotal Funding
$5MKey Investors
The John M. O'Quinn FoundationBlue Cross and Blue Shield of Texas
2022-08-02Grant· $5M
2022-07-07Grant
Leadership Team
Michael Roussos
SVP, President of Academic Hospitals and CEO, Memorial Hermann-Texas Medical Center Campus
David Wong, MD
Director, Virtual Health Product Management
Recent News
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