Revenue Cycle Management (RCM) Consultant - CarelonRx

Key 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.

Minimum Requirements

• 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.

Preferred qualifications

• 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.

Pay

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

Benefits

• A comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401(k) contribution
• Stock purchase plan
• Life insurance
• Wellness programs and financial education resources