Remote RCM Consultant: Claims & Reimbursement Expert

Phamily; Ohio; Remote; USD 83,000 - 124,000; Part time

Job summary

Phamily seeks an experienced Revenue Cycle Management (RCM) Consultant to audit billing accuracy, identify discrepancies, and optimize reimbursement for healthcare system clients. You will independently review claims, CPT/HCPCS/ICD-10-CM coding, and payer requirements to reduce leakage and improve outcomes.

This role partners with internal teams and client sites, providing actionable recommendations and driving compliant, efficient billing practices across diverse payer types.

Qualifications

• 5+ years hands-on experience in healthcare revenue cycle management and insurance billing.
• Expertise in CPT, HCPCS, ICD-10-CM coding and payer-specific rules.
• Proven ability to audit claims independently and identify reimbursement discrepancies.
• Experience with Epic, Oracle Health/Cerner or other EHR/billing platforms.
• Strong analytical skills and ability to improve denial rate and revenue leakage.

Responsibilities

• Conduct detailed audits of claims, billing records, coding, and documentation.
• Validate CPT/HCPCS/ICD-10-CM codes and payer-specific billing requirements.
• Identify inaccurate coding, missed charges, duplicate billing, and underpayments.
• Verify claims meet Medicare, Medicaid, and commercial payer rules.
• Evaluate end-to-end billing workflows, denials, and payment reconciliation.
• Identify revenue leakage and opportunities to improve reimbursement capture.
• Analyze denied or underpaid claims to determine root causes and corrective actions.
• Recommend improvements to increase clean claim rates and billing accuracy.
• Serve as a billing subject matter expert for healthcare system clients.
• Evaluate client practices and provide recommendations to improve accuracy and compliance.
• Support client discussions on coding, documentation, and payer requirements.
• Provide guidance on CMS regulations and payer guidelines.
• Assess compliance risks and propose corrective actions.
• Develop standardized claims audit procedures and best practices.
• Collaborate with Clinical Operations, Product, Technology, and Finance teams.

Skills

Healthcare revenue cycle management

Insurance billing

Medical coding

Claims auditing

Reimbursement consulting

Epic

Oracle Health/Cerner

Tools

Epic

Oracle Health/Cerner

Job description

Phamily seeks an experienced Revenue Cycle Management (RCM) Consultant to audit billing accuracy, identify discrepancies, and optimize reimbursement for healthcare system clients. You will independently review claims, CPT/HCPCS/ICD-10-CM coding, and payer requirements to reduce leakage and improve outcomes.

This role partners with internal teams and client sites, providing actionable recommendations and driving compliant, efficient billing practices across diverse payer types.