Healthcare Technology Consulting Revenue Cycle Architect at Guidehouse

Job Family:Technology ConsultingTravel Required:Up to 50%Clearance Required:NoneWhat You Will Do:Guidehouses Health IT Solutions team works with clients to measurably improve their technology outcomes through a mix of IT strategies improvement in IT operations and adoption of technology initiatives. By leveraging a deep understanding of health system IT operational best practices supported by data Guidehouse propels IT operational improvement and technology adoption across departments and service lines at client organizations.The Revenue Cycle Architect provides deep expertise across Oracle Healths end-to-end revenue cycle ecosystem including RevElate legacy Cerner/Oracle RCM modules EDI interfaces financial workflows and operational design.The architect leads the translation of revenue cycle operations into system build testing strategies data/financial integrity models and future-state operational workflows.This role is not a cloud engineer but must understand how OCI hosting impacts RevElate EDI claim flows environment refresh cycles and operational performance.Key Responsibilities:Revenue Cycle Domain ArchitectureLead enterprise architecture across Patient Access Revenue Integrity Charge Services Billing Claims PFS HIM and Financial Clearance.Translate revenue cycle operational requirements into system design build standards and workflow architecture.Define encounter models charge logic pathways claims and remittance flows and cross-functional handoffs between clinical operations and revenue operations.Serve as the domain authority for RevElates account structure workflow logic reconciliation models and operational implications.RevElate Design & OptimizationProvide subject-matter leadership on RevElateincluding:Account structure modelingCharge event logicClaim creation and submission rulesWorkqueues and staff workflowsConversion considerations (pre- and post-go-live)Translate legacy workflows into RevElate equivalents identifying operational and financial risks.Data Migration Leadership (Financial & Revenue Cycle)Oversee the revenue cycle components of data migration including:Encounter conversionCharge payment and adjustment data mappingAged A/R strategy (what to convert vs. close out)Reconciliation models and validation rulesGuide the financial integrity review cycles and defect remediation workflows.Testing Strategy & Financial IntegrityDesign comprehensive revenue cycle test plans that reflect:End-to-end operational flowsCharge capture accuracyPayer-specific rules and CRD/accelerated editsClaims logic and denial scenario testingReimbursement modeling underpayment triggers and audit checkpointsPartner with testing leadership to ensure scenarios cover complex payer mixes (Medicaid Medicare commercial workers comp).EDI Integrations & Payer ConnectivityOversee design and alignment across all revenue cycle-related interfaces:X12/EDI (837/835 270/271 278 attachments secondary claims)Eligibility/authorization workflowsPayer-specific nuance (Medicaid state rules coverage carve-outs program-specific edits)Ensure integration design supports real-time revenue cycle operations and financial performance.Cutover & Go-Live Revenue Cycle StrategyLead the revenue cycle planning for cutover including:Encounter/account preparationFreeze logic for claims and charge processingTransitional workflows (split claims shadow claims manual reconciliation)Charge capture and clinical documentation dependenciesEnsure stability in day 190 revenue operations and defect triage.Applied OCI Knowledge (Not a Cloud Architect)While not responsible for cloud design must clearly understand how OCI impacts revenue cycle through:Environment provisioning and refresh cyclesIntegration latency and message throughputRevElate performance behaviors on OCIDowntime workflows and revenue cycle contingency planningEDI and clearinghouse connectivity pathwaysDR/BCP implications for billing claims authorizations and front-end operationsCross-Functional LeadershipCollaborate with clinical technical integration data migration and operational leads to ensure cohesive end-to-end design.Mentor analysts and builders working across revenue cycle domains.Establish governance standards and reusable patterns for the EHR CoE.Client & Executive CommunicationServe as a trusted advisor to CFOs VPs of Revenue Cycle PFS Directors Clinical/Operational Leadership and CIO/CTO partners.Communicate revenue cycle impacts and design decisions clearly including risks and mitigation options.What You Will Need:Bachelors degree5 years of Oracle Health revenue cycle experience spanning multiple domains.Experience with RevElateworkflow logic build account structure and operational impacts.Expertise in:Revenue cycle architecture and future-state designEDI/claim workflows and payer rulesFinancial testing and reimbursement modelingData migration (financial/encounter data)Cutover planning for revenue cycle operationsStrong understanding of how OCI hosting affects revenue cycle performance.Ability to lead teams in complex multi-vendor implementations.Strong grounding in hospital and ambulatory revenue cycle operations.What Would Be Nice To Have:Experience with large-scale EHR modernization.Background with AMCs IDNs multi-hospital networks or state agencies.Familiarity with CRD coverage rules engines authorization workflows and Medicaid-specific requirements.Prior consulting experience.The annual salary range for this position is $130000.00-$216000.00. Compensation decisions depend on a wide range of factors including but not limited to skill sets experience and training security clearances licensure and certifications and other business and organizational needs.What We Offer:Guidehouse offers a comprehensive total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.Benefits include:Medical Rx Dental & Vision InsurancePersonal and Family Sick Time & Company Paid HolidaysPosition may be eligible for a discretionary variable incentive bonusParental Leave and Adoption Assistance401(k) Retirement PlanBasic Life & Supplemental LifeHealth Savings Account Dental/Vision & Dependent Care Flexible Spending AccountsShort-Term & Long-Term DisabilityStudent Loan PayDownTuition Reimbursement Personal Development & Learning OpportunitiesSkills Development & CertificationsEmployee Referral ProgramCorporate Sponsored Events & Community OutreachEmergency Back-Up Childcare ProgramMobility StipendAbout GuidehouseGuidehouse is an Equal Opportunity EmployerProtected Veterans Individuals with Disabilities or any other basis protected by law ordinance or regulation.Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.If you have visited our website for information about employment opportunities or to apply for a position and you require an accommodation please contact Guidehouse Recruiting at 1- or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @ or . Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.If any person or organization demands money related to a job opportunity with Guidehouse please report the matter to Guidehouses Ethics Hotline. If you want to check the validity of correspondence you have received please contact . Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicants dealings with unauthorized third parties.Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee. Key Skills Business Development,Apprentice,Asset Management,ABAP,IT Strategy,Manufacturing Employment Type : Full-Time Experience: years Vacancy: 1 Monthly Salary Salary: 130000 - 216000