Revenue Cycle Management (RCM) Consultant - CarelonRx

About the role

This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Responsibilities

• Develop and maintain enterprise or function-level revenue cycle standards, policies, procedures, and governance practices to support consistent execution and compliance.
• Evaluate revenue cycle operations across teams and sites, identify structural improvement opportunities, and recommend reengineered workflows and operating models.
• Advise leaders on automation opportunities across eligibility, authorization, claim edits, denial prevention, appeals, payment posting, underpayment detection, and work queue routing.
• Lead complex cross-functional initiatives involving process standardization, technology enablement, performance management, and organizational change.
• Design rollout plans, audit-ready controls, KPI dashboards, and governance cadences to ensure improvements are sustained post-implementation.
• Serve as a subject matter expert for RCM best practices, payer rules, revenue leakage risk, and scalable operating design.

Requirements

• Requires a BA/BS in accounting or finance and a minimum of 3 years experience in general accounting, finance, or budget and planning; or any combination of education and experience, which would provide an equivalent background.
• MBA, CPA, or CMA preferred.
• In depth revenue cycle experience, in pharmacy preferred.
• Experience in consulting, shared services, multi-site healthcare, or enterprise transformation environments.
• Exposure to automation tools, workflow orchestration, analytics platforms, or AI-enabled RCM solutions.
• Experience supporting policy standardization and operational redesign across multiple business units or functions.

Qualifications

• Preferred qualifications include in-depth revenue cycle experience, in pharmacy preferred.
• Experience in consulting, shared services, multi-site healthcare, or enterprise transformation environments.
• Exposure to automation tools, workflow orchestration, analytics platforms, or AI-enabled RCM solutions.
• Experience supporting policy standardization and operational redesign across multiple business units or functions.

Benefits

CarelonRx is a proud member of the Elevance Health family of companies. Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

Pay

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Schedule

Associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

Equal Opportunity Employer

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.