Revenue Cycle Management Consultant

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $30 - $40 / hour

⏳ Contract/Temporary

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

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Phamily

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Phamily is an industry-leading in-house Chronic Care Management (CCM) and Proactive Care platform. The company supports health systems and medical groups nationwide by launching scalable in-house CCM service lines. This enables proactive patient support between visits and delivers sustainable monthly reimbursement without the need for outsourcing. Phamily is known for its cutting-edge technology that improves patient wellness, delivers superior preventative care, and maximizes organizational sustainability. The platform documents care management seamlessly and provides smart care plan templates. Catering to 20+ specialties across 33 states, Phamily enhances patient experience with high engagement rates and reduces hospitalizations significantly. With Phamily, organizations can manage 500 patients per full-time clinical worker, generating substantial revenue and profit.

📋 Description

• Conduct detailed audits of medical claims, billing records, coding, and supporting clinical documentation • Validate CPT, HCPCS, ICD-10-CM codes, modifiers, and payer-specific billing requirements • Identify inaccurate coding, missed charges, duplicate billing, underbilling, and reimbursement discrepancies • Verify claims meet Medicare, Medicaid, and commercial payer billing and documentation requirements • Evaluate end-to-end billing workflows, including charge capture, claims submission, denials, and payment reconciliation • Identify revenue leakage, missed reimbursement opportunities, and operational inefficiencies • Analyze denied, rejected, and underpaid claims to determine root causes and recommend corrective actions • Recommend improvements to increase billing accuracy, clean claim rates, and reimbursement capture • Serve as a billing and reimbursement subject matter expert for healthcare system clients • Partner with client revenue cycle and billing teams to investigate and resolve billing discrepancies • Evaluate client billing practices and provide recommendations to improve accuracy, compliance, and reimbursement • Support client discussions involving coding, documentation, payer requirements, and billing processes • Provide guidance on CMS regulations, Medicare billing guidelines, and commercial payer requirements • Assess billing compliance risks and recommend corrective actions • Develop standardized claims audit procedures, quality assurance controls, and billing best practices • Collaborate with Clinical Operations, Product, Technology, and Finance teams to improve billing workflows and supporting documentation

🎯 Requirements

• 5+ years of hands-on experience in healthcare revenue cycle management, insurance billing, medical coding, claims auditing, or reimbursement consulting • In-depth experience with Epic, Oracle Health/Cerner, or other EHR and billing platforms • Extensive expertise in Medicare, Medicaid, and commercial insurance billing and reimbursement requirements • Advanced knowledge of CPT, HCPCS, ICD-10-CM coding, modifiers, and payer-specific billing rules • Proven experience independently auditing medical claims, identifying coding errors, and resolving reimbursement discrepancies • Demonstrated ability to identify revenue leakage, reduce denials, and improve billing accuracy and reimbursement outcomes • Experience working with healthcare systems, physician groups, medical practices, or healthcare revenue cycle organizations • Strong analytical skills with the ability to review complex billing data, identify trends, and translate findings into actionable recommendations • Ability to work independently, manage consulting deliverables, and communicate effectively with internal stakeholders and healthcare system clients

🏖️ Benefits

• Competitive compensation based on experience and impact • Comprehensive medical, dental, and vision coverage for employees and dependents at a low cost • Up to 35 paid days off each year • 12 vacation days accrued annually • Up to 9 sick/wellness days • 12 paid company holidays • 2 Paid Give-Back Days • HSA and FSA account options • 401(k) with company match after 6 months of full-time employment • 100% match on the first 3% contributed, and 50% match on the next 2% contributed • Collaborative, mission-driven team helping transform healthcare at scale

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