Revenue Cycle Management Consultant

This is a fully remote position, open to applicants in United States.

📋 Description

• Perform comprehensive audits of medical claims, billing records, coding, and accompanying clinical documentation.

• Confirm the accuracy of CPT, HCPCS, ICD-10-CM codes, modifiers, and payer-specific billing guidelines.

• Detect errors in coding, missed charges, duplicate billings, underbilling, and inconsistencies in reimbursements.

• Ensure that claims adhere to Medicare, Medicaid, and commercial payer billing and documentation standards.

• Assess complete billing processes, including charge capture, claims submission, denials, and reconciliation of payments.

• Identify areas of revenue loss, missed reimbursement chances, and operational inefficiencies.

• Analyze claims that have been denied, rejected, or underpaid to uncover root causes and suggest corrective measures.

• Propose enhancements to boost billing accuracy, clean claim rates, and reimbursement recovery.

• Act as a subject matter expert in billing and reimbursement for clients in the healthcare sector.

• Collaborate with client revenue cycle and billing teams to investigate and rectify billing inconsistencies.

• Review client billing practices and offer recommendations for improved accuracy, compliance, and reimbursement.

• Assist in client discussions related to coding, documentation, payer requirements, and billing processes.

• Provide insights on CMS regulations, Medicare billing standards, and requirements from commercial payers.

• Evaluate billing compliance risks and suggest corrective strategies.

• Establish standardized procedures for claims audits, quality assurance measures, and best practices for billing.

• Work in partnership with Clinical Operations, Product, Technology, and Finance teams to enhance billing workflows and necessary documentation.

⛳️ Requirements

• Over 5 years of direct experience in healthcare revenue cycle management, insurance billing, medical coding, claims auditing, or reimbursement consulting.

• Extensive experience with Epic, Oracle Health/Cerner, or other EHR and billing systems.

• Profound knowledge of Medicare, Medicaid, and commercial insurance billing and reimbursement regulations.

• Advanced understanding of CPT, HCPCS, ICD-10-CM coding, modifiers, and specific billing rules for various payers.

• Demonstrated expertise in independently auditing medical claims, pinpointing coding mistakes, and resolving reimbursement issues.

• Proven track record of identifying revenue loss, minimizing denials, and enhancing billing accuracy and reimbursement results.

• Experience collaborating with healthcare systems, physician groups, medical practices, or revenue cycle organizations.

• Strong analytical capabilities to review intricate billing data, recognize trends, and convert findings into actionable strategies.

• Ability to work autonomously, oversee consulting deliverables, and communicate effectively with internal stakeholders and healthcare system clients.

🏝️ Benefits

• Competitive salary based on experience and contributions.

• Comprehensive medical, dental, and vision insurance for employees and their dependents at a low cost.

• Up to 35 paid days off annually.

• 12 vacation days accrued each year.

• Up to 9 sick/wellness days available.

• 12 paid holidays recognized by the company.

• 2 Paid Give-Back Days for community service.

• Options for Health Savings Account (HSA) and Flexible Spending Account (FSA).

• 401(k) plan with company matching contribution after 6 months of full-time employment.

• 100% match on the first 3% contributed, and 50% match on the subsequent 2% contributed.

• Join a collaborative, mission-driven team dedicated to transforming healthcare on a large scale.