RCM Operations Consultant (Part-Time)

Position Summary We are seeking an experienced RCM (Revenue Cycle Management) Operations Consultant to provide expert guidance, process auditing, and workflow optimization for our Billing Team. This consultant will evaluate the end-to-end billing lifecycle, identify gaps, strengthen compliance, and recommend improvements that enhance efficiency, accuracy, and revenue integrity. This is not a production role; the consultant will not perform day-to-day billing tasks. Instead, they will act as a strategic partner focused on auditing, diagnosing issues, and creating sustainable solutions within our billing workflows. Candidates with experience in mental health billing and full end-to-end RCM are strongly preferred. Key Focus Areas: 1. Workflow Optimization & Process Improvement: -Evaluate current billing workflows, from scheduling and documentation review to claims submission and payment posting. -Identify inefficiencies, bottlenecks, rework, or breakdowns in communication. -Recommend and document optimized processes, SOP revisions, and best-practice workflows. -Provide guidance to leadership on how to structure the billing team for improved efficiency and accountability. 2. Auditing of Billing Processes: -Using the billing team’s day-to-day tasks as reference, the consultant will audit processes, including: -Copay verification and collection workflow. -Code selection (CPT/HCPCS) accuracy and charge entry procedures. -Claim creation, edits, batching, and submission. -Insurance payment posting accuracy and reconciliation. -Management of denials, discrepancies, and payer follow-up procedures. Audit goals include: -Ensuring accuracy, compliance, and timeliness throughout the revenue cycle. -Identifying patterns of errors, avoidable rejections, or preventable denials. -Recommending corrective actions, SOP updates, and training enhancements. 3. Compliance & Best Practices Review: -Assess adherence to HIPAA, payer-specific requirements, and industry coding standards. -Review documentation processes against Medicaid and commercial insurance guidelines. -Provide recommendations to strengthen compliance and reduce future risk. 4. Cross-Department Collaboration: -Evaluate communication flow between Billing, AR, Credentialing, Scheduling, and Clinical teams. -Recommend clearer handoffs, accountability structures, and communication protocols. -Support leadership by identifying training needs and areas requiring clearer ownership. 5. Reporting & Leadership Support: -Provide written audit summaries, assessment reports, and practical implementation recommendations. -Advise on KPI development (e.g., clean-claim rate, first-pass payment rate, denial rate, reconciliation timeliness). -Offer guidance for long-term process stability and scalable RCM systems. Required Qualifications: -5+ years of progressive experience in Revenue Cycle Management (RCM) within the healthcare industry. -Strong background in auditing workflows, identifying root causes, and implementing operational improvements. -Deep understanding of claims lifecycle, charge posting, payment posting, denial management, and payer rules. -Ability to work independently, diagnose operational issues, and provide actionable recommendations. -Availability to work PST hours. Preferred / Nice-to-Have: -Experience in mental or behavioral health billing. -Expertise in full end-to-end RCM within multi-provider or multi-location environments. -Familiarity with systems such as TheraNest, EZClaim, and Waystar. -Experience creating SOPs, training, and billing performance dashboards. Apply tot his job