RCM Architect
Defines RCM standards and translates billing complexity into strategies, workflows, and insights across Sales, Customer Success, Product, and Operations. Owns outcomes like reducing denials through audits, denial pattern resolution, SOPs, and cross-functional enablement. Requires 8+ years RCM expertise in denials and claims.
About the job
Responsibilities
- Audit claims and drive strategy: Review claims for accuracy, validate next-best-action decisions, and translate findings into systemic recommendations.
- Turn denial data into actionable workflows: Translate denial patterns into root causes, resolution pathways, standardized recovery strategies, escalation logic, and decision frameworks.
- Codify RCM knowledge at scale: Build and maintain SOPs, specialty guides, and decision frameworks.
- Set every new customer up for success: Analyze denial rates, aging, payer mix, workflow gaps at onboarding and deliver data-backed strategic action plans.
- Enable the organization: Support new hire onboarding, partner with Product and Engineering on feature release training, communicate industry changes.
- Shape what gets built: Serve as embedded RCM SME in product development, contribute to PRDs, surface edge cases.
- Power the sales motion: Provide pre-sales RCM analysis, create specialty-specific enablement materials, review outbound copy.
- Be the expert on escalations: Partner on complex customer challenges, feed systemic insights into product roadmap and workflows.
Requirements
Experience:
- 8+ years in Revenue Cycle Management with deep expertise in denials, AR follow-up, and payer behavior.
- Hands-on experience analyzing claims data, denial trends, and revenue performance across multiple payers and specialties.
- Experience working across functions (Sales, Operations, Product).
- Experience designing or improving RCM workflows, SOPs, or decision frameworks.
- Track record of using AI tools, automation, or data.
Qualities:
- Systems thinker focused on root causes, patterns, and scalable solutions.
- Outcome-oriented with result tracking.
- Comfortable as the go-to expert for unclear situations.
- Analytical and data-driven.
- Low ego, high ownership.
Skills
Revenue Cycle Management, Claims Analysis, Denials Management, Ar Follow-Up, Payer Behavior Analysis, Claims Data Analysis, Rcm Workflows, Sop Development, AI Tools, Data Analysis
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