About Jaan Health: Chronic Health Management Platform for US

<h1><strong>Revenue Cycle Management (RCM) Consultant</strong></h1> <p>Location: Remote</p> <p>Travel Expectations: Up to 20% to client sites, as assigned</p> <p>Job Type: Contractor (1-month assignment; option to extend)</p> <p>Job Reports To: Senior Director, Managed Services</p> <p>Pay Rate: $30.00-40.00/hour</p> <p> </p> <h3><strong>About Jaan Health/Phamily </strong></h3> <p>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.</p> <p>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.</p> <h3><strong>Job/Role Description: </strong></h3> <p>Phamily is seeking an experienced Revenue Cycle Management (RCM) Consultant with deep expertise in healthcare insurance billing, medical coding, claims auditing, and reimbursement optimization.</p> <p>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.</p> <p>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.</p> <p> </p> <h3><strong>Key Responsibilities: </strong></h3> <h3><strong>Claims Auditing &amp; Billing Accuracy</strong></h3> <ul> <li>Conduct detailed audits of medical claims, billing records, coding, and supporting clinical documentation.</li> <li>Validate CPT, HCPCS, ICD-10-CM codes, modifiers, and payer-specific billing requirements.</li> <li>Identify inaccurate coding, missed charges, duplicate billing, underbilling, and other reimbursement discrepancies.</li> <li>Verify that claims meet Medicare, Medicaid, and commercial payer billing and documentation requirements.</li> </ul> <h3><strong>Revenue Cycle &amp; Reimbursement Optimization</strong></h3> <ul> <li>Evaluate end-to-end billing workflows, including charge capture, claims submission, denials, and payment reconciliation.</li> <li>Identify revenue leakage, missed reimbursement opportunities, and operational inefficiencies.</li> <li>Analyze denied, rejected, and underpaid claims to determine root causes and recommend corrective actions.</li> <li>Recommend improvements to increase billing accuracy, clean claim rates, and reimbursement capture.</li> </ul> <h3><strong>Healthcare System Client Consulting</strong></h3> <ul> <li>Serve as a billing and reimbursement subject matter expert for Phamily's healthcare system clients.</li> <li>Partner with client revenue cycle and billing teams to investigate and resolve billing discrepancies.</li> <li>Evaluate client billing practices and provide recommendations to improve accuracy, compliance, and reimbursement.</li> <li>Support client discussions involving coding, documentation, payer requirements, and billing processes.</li> </ul> <h3><strong>Compliance &amp; Process Improvement</strong></h3> <ul> <li>Provide guidance on CMS regulations, Medicare billing guidelines, and commercial payer requirements.</li> <li>Assess billing compliance risks and recommend corrective actions.</li> <li>Develop standardized claims audit procedures, quality assurance controls, and billing best practices.</li> <li>Collaborate with Phamily's Clinical Operations, Product, Technology, and Finance teams to improve billing workflows and supporting documentation.</li> </ul> <p> </p> <h3><strong>Requirements: </strong></h3> <ul> <li>5+ years of hands-on experience in healthcare revenue cycle management, insurance billing, medical coding, claims auditing, or reimbursement consulting.</li> <li>In-depth experience with Epic, Oracle Health/Cerner, or other EHR and billing platforms.</li> <li>Extensive expertise in Medicare, Medicaid, and commercial insurance billing and reimbursement requirements.</li> <li>Advanced knowledge of CPT, HCPCS, ICD-10-CM coding, modifiers, and payer-specific billing rules.</li> <li>Proven experience independently auditing medical claims, identifying coding errors, and resolving reimbursement discrepancies.