Healthcare Technology Consulting - Revenue Cycle Management (RCM) Functional Lead

Job Family:

Technology Consulting

Travel Required:

Up to 50%

Clearance Required:

None

Guidehouse’s 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. 

What You Will Do:

The Technical Healthcare Revenue Cycle Lead will oversee the design, configuration, validation, and deployment of an ERP solution across the entirety of a health system for a public client . This role requires deep expertise in public sector healthcare billing, including long-term care, behavioral health, and pharmacy operations. The Lead will serve as the primary liaison between the Revenue Cycle Advisory Council, client health teams, and stakeholders, ensuring that the solution meets the client's complex financial, regulatory, and operational requirements. 

Key Responsibilities:

• Revenue Cycle Design and Configuration
• Lead the functional design and configuration of ERP solutions, ensuring alignment with client billing workflows, including long-stay inpatient billing, trust account management, and pharmacy claims
• Develop and validate workflows for interim monthly billing, Medicare Part D, Medicaid eligibility, and resident trust accounts
• Oversee the upload and validation of the Charge Description Master (CDM), ensuring CPT/HCPCS code alignment with procedures and services
• Collaborate with the Patient Accounting and Practice Management teams to configure registration, scheduling, and eligibility workflows
• Design and validate EMRN/MRN strategies to support cross-agency patient identity management
• Ensure compliance with federal and state clients, CMS and HFMA MAP standards for billing, reimbursement, and financial reporting
• State-Specific Revenue Cycle Requirements
• Translate client-specific billing needs into system requirements, including: 
• Long-term care billing cycles and interim claims
• Resident trust account workflows, including deposits, withdrawals, and reconciliation
• Federal/state community services billing, including vendor-submitted claims and EIM system integration.
• Service authorization workflows and capacity management for behavioral health services
• Integrations for financial tracking and reporting
• Collaborate with state finance and compliance teams to ensure accurate grant and funding reports for state and federal programs.
• Testing and Validation
• Lead parallel revenue cycle testing, reconciling results with legacy MEDITECH systems
• Validate charge capture, claims generation, eligibility verification, and electronic remittance advice (ERA) posting
• Ensure readiness for day-one revenue cycle operations, including cash flow continuity and billing compliance
• Collaborate with Testing Lead and Data Migration Lead to validate financial data accuracy and integrity
• Stakeholder Engagement and Governance
• Serve as the primary point of contact for revenue cycle stakeholders, including the Revenue Cycle Advisory Council, billing teams, HIM, and finance leadership
• Participate in Change Control Board (CCB) and Steering Committee meetings to evaluate financial impacts of scope changes
• Provide executive-level reporting on revenue cycle readiness, risk posture, and performance metrics
• Facilitate workshops and design sessions with state agencies to gather requirements and validate workflows

What You Will Need:

• Bachelors Degree
• Minimum 5 years of leadership experience in healthcare revenue cycle operations roles
• Proven experience implementing Oracle Health RevElate in public sector or complex payer environments. 
• Deep understanding of State and Federal billing requirements, including long-stay inpatient billing, trust accounts, and behavioral health reimbursement
• Experience with HFMA MAP standards and other industry-recognized revenue cycle frameworks
• Familiarity with Medicaid, Medicare Part D, and state-specific billing systems  
• Strong knowledge of CDM management, charge capture workflows, and denial prevention strategies
• Excellent communication, stakeholder engagement, and documentation skills

What Would Be Nice To Have:

• HFMA certification or equivalent credential
• Experience with federal/state EHR implementation projects
• Familiarity with Oracle Health Data I