Phamily

Consultant

• 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 reimbursement discrepancies
• Verify 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 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
• 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 Clinical Operations, Product, Technology, and Finance teams to improve billing workflows and supporting documentation

Explore Revenue Cycle Management Consultant at Phamily. Review requirements and application details.

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Revenue Cycle Management Consultant