Revenue Cycle Management (RCM) Consultant

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

Revenue Cycle Management (RCM) Consultant Location: Remote Travel Expectations: Up to 20% to client sites, as assigned Job Type: Contractor (1-month assignment; Job Reports To: Senior Director, Managed Services

About Jaan Health/Phamily

Jaan Health is a leading AI-based care management company serving healthcare providers. For nearly a decade, the company has leveraged its easy-to-use, proprietary technology to enable health systems, medical groups, and ACOs to deliver high-quality, high-ROI proactive care to hundreds of thousands of previously underserved patients.

Phamily, the company's core technology platform, has transformed chronic disease management with clinically tested AI and easy-to-use technology that enables physicians and care teams to offer high-touch, individualized patient care that has been proven to reduce investment in extra labor and the overall cost of care. Phamily helps ensure healthcare providers are compensated fairly for providing high-quality care between office visits, while improving the lives of patients with chronic diseases. Phamily is seeking an experienced Revenue Cycle Management (RCM) Consultant with deep expertise in healthcare insurance billing, medical coding, claims auditing, and reimbursement optimization.

This consultant will serve as a subject matter expert, partnering with Phamily's internal teams and healthcare system clients to evaluate billing accuracy, identify revenue leakage, resolve claims discrepancies, and improve reimbursement outcomes.

The ideal consultant is a hands-on expert who can independently audit claims, assess billing and coding practices, identify operational gaps, and provide actionable recommendations to ensure healthcare system clients accurately capture and receive reimbursement for eligible services.

Claims Auditing & Billing Accuracy

• 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 other reimbursement discrepancies.
• Verify that claims meet Medicare, Medicaid, and commercial payer billing and documentation requirements.

Revenue Cycle & Reimbursement Optimization

• 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.

Healthcare System Client Consulting

• 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.

Compliance & Process Improvement

• 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 Phamily's Clinical Operations, Product, Technology, and Finance teams to improve billing workflows and supporting documentation.

• 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.

every employee at Jaan Health must embody growth company DNA. You are both a playbook builder and executor, able to design scalable approaches for today while anticipating what the business will need tomorrow, and then follow through to deliver results.

Care: We put patients, clients, teammates, and outcomes first.

Craftsmanship: We execute with excellence, ownership, and continuous improvement.

You’ll join a smart, humble, and collaborative team dedicated to improving healthcare.

We celebrate diversity and are committed to creating an inclusive environment for all employees. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, genetics, veteran status, sexual orientation, gender identity or expression, or any other legally protected status.

This position is responsible for complying with all organizational security, privacy, and compliance policies applicable to the role, including separation of duties requirements, and for protecting the confidentiality, integrity, and availability of the information and systems they access.