Revenue Integrity Program Manager Jobs in Houston, TX

About The Wilshire Group 

The Wilshire Group, a renowned boutique consulting firm in Los Angeles, specializes in revenue cycle optimization and fostering effective collaboration between operational and IT facets.  With a robust track record of aiding over 100 healthcare systems nationwide, our team thrives on professionalism, efficiency, and adaptability.

Our core values- professionalism, efficiency, and flexibility- underscore our commitment to creating an inclusive and dynamic workplace.  We embrace diverse narratives and believe in offering opportunities to exceptional individuals who bring their best to the table.

We are currently offering a contracted interim position at one of US News Best Hospitals 2022-23.  This position caters to top performers seeking a professional environment that acknowledges and values their dedication and proficiency.  While this role doesn't offer benefits, it presents an opportunity to work within an organization that encourages talented individuals to surpass conventional boundaries.

Join us at The Wilshire Group, a place where talented professionals find a home to showcase their skills and contribute meaningfully to the healthcare landscape.

Revenue Integrity Consultant

Position: Revenue Integrity Consultant
Work Arrangement: Remote
Compensation: $60-$65 per hour
Employment Type: Full-Time

 The Wilshire Group is seeking an experienced Revenue Integrity Consultant to join our team and support client engagements focused on revenue integrity, charging, compliance, and optimization. This is a highly collaborative, client-facing role requiring strong hospital revenue cycle experience, a deep understanding of Epic, and the ability to identify opportunities that improve financial performance, operational efficiency, and revenue integrity.

Our consultants work directly with clients across a variety of engagements, including assessments, implementations, post-live stabilization, optimization initiatives, strategic projects, and ongoing support. Successful consultants are adaptable, analytical, and comfortable working across both operational and technical environments.

Responsibilities

• Partner with client teams to assess current revenue integrity processes and identify opportunities for improvement.
• Provide comprehensive Chargemaster (CDM) expertise across both Hospital Billing (HB) and Professional Billing (PB). CDM Consolidation experience for a new install or an Epic Refuel is a requirement for this role.
• Review CDM structure, maintenance, and processes to identify revenue leakage, charging issues, and opportunities for improved charge capture.
• Evaluate and align revenue codes with appropriate hard-coded and soft-coded charging requirements.
• Analyze charging workflows and provide strategic recommendations to improve revenue integrity and compliance.
• Identify and support optimization opportunities related to CDM management, maintenance, and integration with clinical and financial Epic modules.
• Apply revenue integrity best practices to support charge capture, billing accuracy, and denial prevention.
• Review revenue cycle processes for compliance with hospital billing requirements and identify potential audit risks.
• Support revenue integrity assessments, implementations, optimization projects, and post-live stabilization activities.
• Collaborate with operational, clinical, financial, and IT stakeholders to develop practical solutions.
• Communicate findings, recommendations, and project status clearly to client leadership and project teams.
• Adapt to varying client needs and provide support across multiple areas of a project when needed.
• Contribute to the continued growth and success of The Wilshire Group through knowledge sharing, collaboration, and professional development.

Qualifications

• 10+ years of revenue integrity experience within a hospital or health system environment.
• Strong knowledge of Epic Hospital Billing (HB) (this role focuses on HB) and Professional Billing (PB) functionality, particularly related to charging and charge capture.
• Comprehensive knowledge of Chargemaster management and revenue integrity operations.
• Working knowledge of CPT coding and its application within revenue integrity operations.
• Experience identifying and addressing charging, billing, and revenue leakage opportunities.
• Knowledge of hospital billing compliance, audits, and denial prevention strategies.
• Experience supporting Epic implementations, optimization, or post-live initiatives.
• Strong analytical, problem-solving, and consulting skills.
• Excellent written and verbal communication skills with the ability to work effectively with client stakeholders at multiple levels.
• Ability to work independently, manage competing priorities, and adapt to changing client needs.
• Bachelor's degree or equivalent combination of education and relevant experience.
• Epic certification preferred/required based on project needs. Not required for this role - the experience working on the operational side is more important.

*For those local to Texas, this job could become contract-to-hire if that is something you are interested in. It would require two weeks onsite in Houston at the beginning of the project, and at least one day a week onsite in Houston for the length of the project. The rest of the days would be remote.

**For someone with a higher level of experience, fully remote candidates (with 1-3 trips to Houston over the course of the project - lasting a year) will be considered.