Billing Consultant

Job Title: Medical Billing Consultant (Revenue Cycle & Denials Specialist)

Location: Winter Haven, FL (On-site preferred; hybrid negotiable)

Reports To: Medical Director / Practice Manager

Position Type: Contract (3–6 month engagement with option to extend)

Position Overview

We are a busy sports medicine practice seeking an experienced Medical Billing Consultant to perform a comprehensive billing audit, optimize our revenue cycle processes, train our team, and aggressively address outstanding denials and underpayments. The consultant will assess current workflows, implement corrective strategies, and ensure compliant, efficient billing practices aligned with CPT, ICD-10, and payer-specific guidelines.

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Key Responsibilities

Revenue Cycle Assessment & Cleanup

- Conduct a full audit of billing, coding, documentation, charge capture, and collections workflows

- Identify trends in denials, underpayments, aging A/R, and missed revenue opportunities

- Reconcile outstanding claims and correct coding/documentation discrepancies

- Develop and implement standardized billing and documentation protocols

Denials & Appeals Management

- Analyze denial patterns by payer, CPT code, and provider

- Prepare and submit comprehensive appeals with appropriate supporting documentation

- Track appeal outcomes and create a denial prevention strategy

- Establish internal processes to reduce future denials and improve first-pass claim acceptance

Coding & Compliance

- Review E/M coding, procedure coding (including MSK ultrasound-guided procedures, injections, DME, etc.), modifier usage, and documentation compliance

- Ensure alignment with current CMS and commercial payer regulations

- Provide clear documentation improvement recommendations to support accurate code selection

Team Training & Process Improvement

- Deliver structured training sessions for providers and billing staff on:

- E/M updates and documentation requirements

- Modifier usage and bundling edits

- Payer-specific rules and authorization requirements

- Develop written SOPs for billing workflows, charge entry, denial tracking, and follow-up

- Create performance dashboards and KPIs (e.g., days in A/R, denial rate, net collection rate)

Ongoing Reporting

- Provide weekly progress updates during the engagement

- Deliver a final report summarizing:

- Financial impact of interventions

- Process improvements implemented

- Recommendations for sustained revenue optimization

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Qualifications

- Certified Professional Coder (CPC), CPB, or equivalent credential preferred

- Minimum 5 years of experience in physician practice billing (Orthopedics and/or Sports Medicine preferred)

- Demonstrated success in reducing denial rates and improving collections

- Strong knowledge of CPT, ICD-10, HCPCS, NCCI edits, and payer policies

- Experience with EHR and practice management systems

- Strong analytical and training/communication skills

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Deliverables

- Cleaned and reconciled aging accounts receivable

- Completed and tracked appeals for all viable outstanding denials

- Written billing workflow manual tailored to the practice

- Staff training sessions completed with reference materials provided

- Measurable reduction in denial rate and improvement in collections

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Compensation

• Competitive contract rate based on experience and scope of work. Performance-based incentives may be considered based on financial recovery benchmarks.