Revenue Cycle Management (RCM) Consultant (Contract)

Remote; San Francisco (CA); A distancia; USD 41.000 - 55.000; A tiempo parcial

Ventajas ofrecidas por este puesto de trabajo

Up to 20% travel

Descripción de la vacante

Jaan Health seeks an experienced Revenue Cycle Management Consultant to optimize reimbursement for healthcare systems. The role focuses on billing accuracy, coding integrity, and claims auditing across Medicare, Medicaid, and commercial payers.

The contractor will partner with Phamily teams and clients to identify revenue leakage and implement corrective actions, including denials reduction and improved clean claim rates, while traveling up to 20% as needed.

Formación

• 5+ years of hands-on experience in healthcare revenue cycle management or reimbursement consulting.
• Experience with Medicare, Medicaid, and commercial payer rules.
• Proven ability to audit claims and resolve reimbursement discrepancies.
• Familiarity with CPT/HCPCS/ICD-10-CM coding and payer requirements.
• Ability to work with healthcare systems and provider groups.

Responsabilidades

• Conduct detailed audits of medical claims, billing records, and coding.
• Validate CPT, HCPCS, ICD-10-CM codes and payer-specific rules.
• Identify underbilling, missed charges, and denial patterns.
• Evaluate end-to-end billing workflows and denials management.
• Provide actionable recommendations to improve reimbursement outcomes.
• Collaborate with client billing teams and internal Phamily groups.

Conocimientos

Healthcare billing

Medical coding

Claims auditing

Reimbursement optimization

Revenue cycle analytics

Herramientas

Epic

Oracle Health

Cerner

Descripción del empleo

Defining the future of work & living globally

5,759 jobs · 6 companies

Revenue Cycle Management (RCM) Consultant

Location: Remote

Travel Expectations: Up to 20% to client sites, as assigned

Job Type: Contractor (1-month assignment; option to extend)

Job Reports To: Senior Director, Managed Services

Pay Rate: $30.00-40.00/hour

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. Learn more at phamily.com.

Job/Role Description:

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.

Key Responsibilities:

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.

Serve as a billing and reimbursement subject matter expert for Phamily's 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.

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.

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.

Work style & logistics

We are a fast-growing, early-stage company with a bold mission and significant work ahead; every employee at Jaan Health must embody growth company DNA. This means you have proven success in a high-performing environment: high velocity, strong ownership, comfort with ambiguity, resilience, and a true growth mindset.

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.

Our culture is built on five principles that shape how we work, lead, and grow:

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

Curiosity: We ask better questions, challenge assumptions, and keep learning.

Clarity: We simplify complexity, communicate directly, and create alignment.

Co-Creation: We collaborate across teams, perspectives, and disciplines.

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

If you take pride in delivering results, embrace challenges, and proactively seek improvement, then this is the place for you. You’ll join a smart, humble, and collaborative team dedicated to improving healthcare.

Phamily is an equal opportunity employer. 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.