Senior Consultant - Healthcare RCM (FQHC, Medi-Cal, CPC/COC)

Overview

Candidates for this role must have healthcare consulting experience, demonstrated Medi-Cal expertise, deep experience within the Federally Qualified Health Center (FQHC) environment, and an active Certified Outpatient Coder (COC) or Certified Professional Coder (CPC) certification to be considered for this role. Candidates must also have significant hands-on experience as a medical coder and extensive knowledge of Medi-Cal reimbursement, medical coding, billing, and healthcare revenue cycle operations.

Success as a Senior Consultant in Revenue Cycle requires the technical expertise, consulting experience, and analytical capabilities needed to advise healthcare organizations, identify opportunities for financial and operational improvement, and deliver measurable, sustainable client results. The ideal candidate has a proven track record of assessing revenue cycle performance, recommending strategic and operational improvements, and partnering with clients to implement solutions that improve financial and operational outcomes.

Job Summary

The Senior Consultant is responsible for helping organizations through healthcare-related research, technical assistance, grant writing, policy analysis, strategic planning, procurements, program development, quality improvement, financial and reimbursement strategies, operational support, evaluation, product development and a range of other tasks. As an experienced expert within the firm, the Senior Consultant is responsible for client services, project management, and supporting the firm’s efforts to develop business through participation in the competitive and/or non-competitive proposal development process.

Responsibilities

Work Performed and Job Requirements

• Client management
• Meets with clients and colleagues to understand requirements.
• Gathers and organizes information about the issue to be solved or the procedure to be improved.
• Analyzes data to identify and understand issues to be addressed.
• Presents findings to internal colleagues, and clients.
• Provides advice, implementation plans, and/or suggestions for improvement, according to project objectives.
• Evaluates client needs, as warranted, and adjusts as appropriate.
• Ensures that all deliverables are high-quality in all aspects (content, grammar, presentation, etc.).
• Serves as a subject matter expert on projects.
• Project management
• Undertakes internal and external short-term and/or long-term project management to address identified issues and needs.
• Develops and documents tools, analysis, frameworks, tracking tools, road maps, dashboards, and/or other approaches to manage a variety of large and small projects.
• Business development
• Supports firm business development activities to expand funded work from existing clients and/or new clients.
• Develops and maintains a pipeline of future work
• Participates in competitive and/or non-competitive proposal development and submission.
• Leadership
• Leads and manages teams, provides developmental feedback, and advances internal initiatives.
• Serves as a mentor for other staff members, as requested.
• Performance metrics
• Ensures performance meets or exceeds HMA expectations in the following areas:
• Billable hour target attainment.
• Manages to budget/project caps established at the outset or assists in negotiating additional fees.
• Meets quality and operational standards.
• Participates in internal activities related to business strategies, forecasts, adoption of new technologies/platforms/approaches, and other process improvements.
• Completes administrative requirements of the role in a punctual manner, including training, reporting, timesheets, expense reports, forecasting, and all other time-sensitive administrative duties.
• All other duties as assigned.

This role requires frequent travel to client sites and HMA offices.

Qualifications

Education/Training

Minimum of a bachelor’s degree in business management, public health, or a related discipline is required. Equivalent work experience in lieu of a bachelor’s degree, although not desired, may be determined as acceptable. A master’s degree in a related discipline is strongly preferred.

Experience

Minimum of 5 years of progressively increasing prior experience in work involving publicly funded healthcare including, but not limited to policy, administration, operations, compliance, research, consulting, or evaluation.

Knowledge, Skills and Abilities

• Strong project management skills.
• Solid time management skills.
• Excellent attention to detail.
• Ability to multi-task and adhere to strict deadlines.
• Capable of handling confidential information in a discreet manner.
• Ability to work extended hours when deadlines are approaching.
• Excellent internal and excellent professional networking skills.
• Excellent critical thinking skills.
• Exceptional oral and written communication skills.
• Superior interpersonal skills, including leadership, contribution to culture, and acceptance of accountability.
• Demonstrated thought leadership and deep expertise in more than one critical healthcare area.
• Ability to maintain an approach to stay current in trends in areas of subject matter expertise.

Core Competencies

Job Level Competencies

• Analytical Thinking - Synthesizes data, trends, and stakeholder input to inform consulting deliverables and recommendations.
• Peer Coaching - Strengthens team capability by providing timely feedback, sharing consulting knowledge, and modeling effective approaches.
• Accountability - Holds self-responsible for quality, timeliness, and results in client-facing work.

EEO

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

Additional Info

This addendum defines the specific expertise, experience, and responsibilities required for success with this Practice area. It supplements the core Job Description and is used for hiring, development, and performance management.

The Senior Consultant is responsible for supporting Revenue Cycle and Medical Coding engagements. This specialization focuses on healthcare revenue cycle services, including:

• Performance improvement planning and implementation
• Revenue cycle process optimization
• Net revenue enhancement
• Professional/outpatient coding services and guidance
• Coding and billing audits
• Medicaid billing technical assistance
• Federally Qualified Health Center (FQHC) billing support
• Denials management

Practice - Finance & Operations – Revenue Cycle

Specific Responsibilities

• Provide accurate, timely guidance on detailed coding and billing questions across a wide variety of provider organizations
• Support FQHC billing and reimbursement improvement projects
• Advise providers on Medicaid and Medicare billing requirements and considerations
• Support revenue cycle improvement projects for hospitals, ambulatory and behavioral health providers
• Analyze large data sets and benchmark key performance indicators.
• Interpret data trends to identify root causes of revenue cycle performance issues.
• Translate analytical findings into improvements that drive measurable financial impact.
• Identify operational bottlenecks and underutilized system functionality.
• Translate complex operational and data insights into clear recommendations.

Preferred Expertise and Knowledge

• At least 3 years of prior management consulting experience in healthcare revenue cycle required.
• Prior work experience in healthcare administration and/or revenue cycle operations highly valued.
• Minimum of 7 years of progressive experience in healthcare revenue cycle, billing, and coding.
• Certified Outpatient Coder (COC) and/or Certified Professional Coder (CPC) with at least 3 years as a practicing coder.
• Deep experience working in the Federally Qualified Health Center environment.
• Demonstrated expertise in Medicare and Medicaid billing rules, claims and enrollment; Medi-Cal experience preferred.
• Advanced data analytics skills, including financial modeling, complex formulas, and data validation techniques.
• Advanced Microsoft Excel proficiency, including pivot tables, complex formulas, data modeling, and structured data analysis; experience with SQL is a bonus.
• Strong understanding of industry-standard revenue cycle key performance indicators and benchmarks.
• Demonstrated ability to apply project management techniques, including workplans, status reporting, resource management, and quality management.
• Ability to work effectively both independently and in collaborative team environments.

Performance Emphasis

Success in this role is measured through:

• Accuracy of coding, billing and reimbursement technical expertise
• Quality of revenue cycle assessment analysis and deliverables.
• Effective application of healthcare revenue cycle experience to support client objectives and financial improvement.
• Client satisfaction, retention, and repeat engagements related to revenue cycle work.
• Quality and effectiveness of data analytics, modeling, and financial reporting outputs.
• Collaboration with internal teams and contribution to knowledge-sharing within the revenue cycle team and Finance and Operations practice.