RCM Architect

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.