Remote RCM Consultant: Healthcare Revenue Optimization

Phamily; Columbus (OH); Remote; USD 100,000 - 156,000; Full time

Job summary

Phamily seeks a Revenue Cycle Management (RCM) Consultant on a remote, 1-month contractor assignment, reporting to Senior Director, Managed Services. The role focuses on auditing claims, optimizing reimbursement, and advising healthcare system clients.

Responsibilities include end-to-end charge capture review, CPT/ICD-10-CM validation, denials analysis, and process improvements across CMS, Medicare, Medicaid, and commercial payers.

Qualifications

• 5+ years of hands-on experience in healthcare revenue cycle management.
• Deep knowledge of Epic, Oracle Health, Cerner or similar EHR systems.
• Extensive Medicare, Medicaid, and commercial payer billing knowledge.
• Proven ability to audit claims and resolve reimbursement discrepancies.
• Strong analytical and communication skills.

Responsibilities

• Conduct detailed audits of medical claims, billing records, coding, and supporting documentation.
• Validate CPT, HCPCS, ICD-10-CM codes, modifiers, and payer-specific billing requirements.
• Identify inaccurate coding, missed charges, duplicate billing, underbilling, and other reimbursement discrepancies.
• Verify that 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 Phamily's healthcare system clients.
• 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.
• Develop standardized claims audit procedures, quality assurance controls, and billing best practices.
• Collaborate with Phamily's Clinical Operations, Product, Technology, and Finance teams to improve billing workflows and supporting documentation.

Skills

Revenue cycle management

Medical coding

Claims auditing

Billing optimization

Healthcare consulting

Tools

Epic

Oracle Health

Cerner

Job description

Phamily seeks a Revenue Cycle Management (RCM) Consultant on a remote, 1-month contractor assignment, reporting to Senior Director, Managed Services. The role focuses on auditing claims, optimizing reimbursement, and advising healthcare system clients.

Responsibilities include end-to-end charge capture review, CPT/ICD-10-CM validation, denials analysis, and process improvements across CMS, Medicare, Medicaid, and commercial payers.