Healthcare Technology Consulting - Revenue Cycle Architect

Job Family:

Technology Consulting

Travel Required:

Up to 50%

Clearance Required:

None

What You Will Do:

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. 

The Revenue Cycle Architect provides deep expertise across Oracle Health’s 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 Architecture

• Lead 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 RevElate’s account structure, workflow logic, reconciliation models, and operational implications.

RevElate Design & Optimization

Provide subject-matter leadership on RevElate—including:

• Account structure modeling
• Charge event logic
• Claim creation and submission rules
• Workqueues and staff workflows
• Conversion 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 conversion
• Charge, payment, and adjustment data mapping
• Aged A/R strategy (what to convert vs. close out)
• Reconciliation models and validation rules
• Guide the financial integrity review cycles and defect remediation workflows.

Testing Strategy & Financial Integrity

Design comprehensive revenue cycle test plans that reflect:

• End-to-end operational flows
• Charge capture accuracy
• Payer-specific rules and CRD/accelerated edits
• Claims logic and denial scenario testing
• Reimbursement modeling, underpayment triggers, and audit checkpoints
• Partner with testing leadership to ensure scenarios cover complex payer mixes (Medicaid, Medicare, commercial, workers comp).

EDI, Integrations & Payer Connectivity

Oversee design and alignment across all revenue cycle-related interfaces:

• X12/EDI (837/835, 270/271, 278, attachments, secondary claims)
• Eligibility/authorization workflows
• Payer-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 Strategy

Lead the revenue cycle planning for cutover including:

• Encounter/account preparation
• Freeze logic for claims and charge processing
• Transitional workflows (split claims, shadow claims, manual reconciliation)
• Charge capture and clinical documentation dependencies
• Ensure stability in day 1–90 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 cycles
• Integration latency and message throughput
• RevElate performance behaviors on OCI
• Downtime workflows and revenue cycle contingency planning
• EDI and clearinghouse connectivity pathways
• DR/BCP implications for billing, claims, authorizations, and front-end operations

Cross-Functional Leadership

• Collaborate with clinical, technical, integration, data migration, and operational leads to ensure cohesive, end-to