If you are interested in joining the SunStone Consulting team, please send your resume and the position your are applying for to inquiries@sunstoneconsulting.com.

 

Senior Consultant Financial Analyst (RCM)

 

Job Description 

Energic team player with a passion for healthcare, dedicated to advancing SunStone Consulting’s consultative solutions effectively and efficiently. The ideal candidate can work independently in a home office setting, is a problem-solver, taking on challenges independently with a strong attention to detail.  This role within the Revenue Cycle Service Line will perform a wide range of activities supporting strategic pricing, managed care contract modeling, CDM review, governmental price transparency and reimbursement solutions. 

Experience in the healthcare finance, revenue cycle and/or payer contracting and reimbursement, as well as a strong business acumen, critical thinking proficiency, and strong communication skills.  SunStone values ingeunity within each team members role which enable us to conntinually enhance our solutions.  An essential ingredient to our success is understanding the critical balance between work and home. 

 

Responsibilities

  • Understand the intricacies of governmental and third party payer reimbursement models for both hospitals and provider practices.

  • Evaluate third party payer contract information received from client, and model contract terms and/or reimbursement in an accurate manner.

  • Develop payer specific rate packages based on the scope of work for each engagement.

  • Be attentive for improvements to internal process improvement opportunities, as well as opportunities to enhance client processes.

  • Collaborate effectively, participating in cross-functional meetings with Service Lines and IT to ensure superior results.

  • Continually validate processes, troubleshooting when necessary, to ensure client objectives.

  • Assist with other reporting and analysis needs, such as data analytics and sampling, maintaining processes/specifications to ensure repeatability.

  • Assist with the development of non-standard reporting, being attentive to new processes that will transform our solutions.

 

Qualifications 

  • Associate or bachelor’s degree in finance, business or economics with a minimum of 5+ years of multi-entity health system and/or related degree or experience.

  • Job duties are project-based, working collaboratively with managers, team members and multiple Service Lines and IT.

  • Proficient with advanced Excel skills (i.e., pivot tables, v-lookups, charts, etc.).

  • Exposure to data tools such as Power BI and SQL is beneficial, though not mandatory.Ability to handle multiple projects and deadlines with an attention to detail and ability to follow instructions to deliver superior results.

  • Demonstrates independent judgment, discretion, accuracy, analytical skills and decision-making abilities.

What You’ll Do:

  • Lead and manage a team of billing specialists, providing guidance, support, and training as needed.

  • Oversee the entire medical billing process, from claim submission to payment collection, ensuring accuracy, timeliness, and compliance with relevant regulations.

  • Monitor and analyze billing data to identify trends, issues, and areas for improvement, and implement necessary changes to optimize billing operations.

  • Collaborate with other departments, such as coding and finance, to resolve billing-related inquiries, discrepancies, and issues.

  • Develop and enforce billing policies and procedures to ensure adherence to industry standards and regulations.

  • Stay updated with changes in medical billing regulations, coding guidelines, and insurance policies, and ensure that the team is trained accordingly.

  • Conduct regular audits of billing processes and records to identify and rectify errors, discrepancies, and potential areas of non-compliance.

  • Generate and analyze billing reports to assess team performance, identify areas for improvement, and provide recommendations for increased efficiency and productivity.

  • Participate in meetings and communicate with management and stakeholders to provide updates on billing operations, challenges, and achievements.

  • Maintain confidentiality of patient records and sensitive billing information, ensuring compliance with HIPAA regulations.

 

What You Bring:

  • Strong leadership skills, with the ability to motivate and supervise a team effectively.

  • Excellent knowledge of medical billing procedures, coding systems, and insurance regulations.

  • Proficient in using EPIC medical billing software and electronic health record (EHR) systems.

  • Attention to detail and strong analytical skills to identify and resolve billing-related issues and discrepancies.

  • Excellent communication and interpersonal skills to effectively collaborate with team members, management, and clients.

  • Ability to work in a fast-paced environment and handle multiple tasks simultaneously, while maintaining a high level of accuracy and efficiency.

  • Strong organizational and time management skills to prioritize tasks and meet deadlines.

  • Problem-solving skills to address billing-related challenges and implement effective solutions.

  • Knowledge of industry best practices, emerging trends, and technological advancements in medical billing.

  • Proficient in Microsoft Office Suite, particularly Excel, for data analysis and reporting.

 

Required Qualifications:

  • Bachelor's degree in healthcare administration, finance, or a related field.

  • Minimum of 3-5 years of experience in medical billing, preferably in a supervisory or leadership role.

  • Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification is preferred.

  • Solid understanding of medical terminology, ICD-10, CPT, and HCPCS coding systems.

  • Familiarity with insurance claim forms, such as CMS-1500 and UB-04.

  • Knowledge of HIPAA regulations and compliance requirements in medical billing.

  • Experience with billing software and EHR systems, such as Epic, Meditech, or Cerner, is required.

  • Strong knowledge of medical billing software, such as Medisoft or Kareo, and proficiency in using billing clearinghouses.

  • Experience in managing and resolving complex billing issues and denials.

  • Strong understanding of revenue cycle management and its impact on the financial health of healthcare organizations.

Preferred Qualifications (Bonus Points!):

  • 3+ years of experience in a medical billing supervisory role.

  • Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification.

 

Work Environment & Physical Demands:

  • This is a remote, home-office based position.

  • You’ll utilize standard office equipment (laptops, smartphones, etc.)

  • Typical work hours are 8:00 am – 5:00pm, Monday through Friday.

  • No travel is expeted

 

Why Join Us?

  • Growth Opportunities: Expand your skills and advance your career.

  • Flexibility:  Enjoy the convenience of a remote work environment.

  • Impactful Work: Co

  • Collaborative Team: Work alongside a supportive and knowledgeable team.