POSITION SUMMARY

The Revenue Cycle Back-End Consultant is responsible for evaluating, optimizing, and implementing improvements across back-end revenue cycle functions. This role focuses on claims management, denials, appeals, payment posting, and collections processes to ensure accurate reimbursement, reduced accounts receivable (AR), and compliance with payer requirements. The consultant will partner with client leadership to design best practices, implement technology solutions, and drive measurable financial performance improvements.

QUALIFICATIONS

• Bachelor’s degree in Healthcare Administration, Finance, Accounting, or related field
• 5+ years of healthcare revenue cycle experience, with focus on back-end functions.
• Deep knowledge of claims processing, denials management, payer policies, collections, and reimbursement methodologies.
• Experience with EHR/HIS platforms (Epic, Cerner, Meditech, or similar) and clearinghouse/billing systems.
• Demonstrated success in reducing AR, improving cash flow, and driving operational efficiency.
• Strong analytical, communication, and problem-solving skills.

PREFERRED SKILLS

• Certification in HFMA, AAHAM, or equivalent revenue cycle management credential.
• Prior consulting or advisory experience within healthcare provider organizations.
• Knowledge of compliance standards (HIPAA, CMS regulations, payer contracts).
• Ability to influence and engage stakeholders at all levels.

• Assessment & Analysis
• Review existing back-end workflows including billing, claims submission, denial management, collections, and payment posting.
• Analyze AR trends, payer performance, denial rates, and write-offs to identify root causes of revenue leakage.
• Benchmark organizational performance against industry standards.
• Process Improvement
• Develop and implement standardized workflows to reduce denials, improve clean claim rates, and shorten AR days.
• Design escalation protocols for complex claims and high-dollar denials.
• Create procedures to optimize coordination between front-end and back-end revenue cycle functions.
• Technology & Systems
• Assess current use of billing systems, clearinghouses, and denial management tools.
• Recommend automation and system optimization opportunities to improve billing accuracy and timeliness.
• Support configuration, testing, and end-user training related to system enhancements.
• Denial & Collections Management
• Develop denial prevention strategies in collaboration with clinical and patient access teams.
• Design and implement robust appeal workflows and templates.
• Establish policies for early-out collections, bad debt, and vendor management.
• Change Management & Training
• Partner with client leadership to roll out improved workflows and reporting structures.
• Train billing, collections, and AR follow-up teams on new procedures.
• Build cross-functional alignment with patient access, coding, and clinical documentation teams.
• Performance Monitoring
• Define KPIs such as clean claim rate, AR days, denial overturn rate, and cash collections.
• Establish dashboards and reporting to track ongoing performance.
• Provide recommendations for continuous improvement and sustainability.