RCM Functional SME/Architect/BA

Role: RCM Functional SME Order-to-Cash

• Lead assessment and optimisation of the end-to-end laboratory revenue cycle from order intake through cash realisation.
• Cover EHR/CPOE, demographics, eligibility, authorisation, medical necessity, compendium, coding, pricing, charge capture, claims, denials, appeals, patient responsibility, cash posting and A/R.
• Identify upstream data-quality issues, revenue leakage and opportunities to improve clean claims, reimbursement and collections.

Role: RCM Functional SME Payer Systems

• Lead payer-facing analysis across the complete Claim-to-Cash lifecycle.
• Assess 837P/837I claims, claim edits, clearinghouse responses, payer adjudication, 835 ERA, CARC/RARC, COB, denials, appeals, resubmissions, timely filing, patient responsibility and payment variance.
• Review payer portals, eligibility and benefits, claim status, remit reconciliation and clearinghouse behaviour.

Role: RCM Techno-Functional SME Core Platform

• Connect end-to-end RCM processes to the core legacy platform and adjacent applications.
• Map eligibility, authorisation, pricing, charge capture, claims, remits, denials, appeals, cash posting, A/R, write-offs and reporting across Gen/CoolGen, COBOL, CICS, DB2, IMS/IDMS, VSAM, JCL/batch, interfaces and extracts.
• Identify safe modernisation, decoupling, externalisation and automation opportunities without disrupting revenue continuity.

Role: RCM Process Design Architect

• Redesign and optimise end-to-end RCM operations across pre-service, service, billing, adjudication, denial recovery, collections, cash application and A/R.
• Improve handoffs, controls and work queues covering order quality, eligibility, authorisation, medical necessity, coding and charge accuracy, clean claims, denial prevention, appeals and payment posting.
• Align future-state processes to payer rules, clearinghouse edits, compliance controls, productivity metrics and measurable outcomes.

Role: RCM Business Analyst

• Support end-to-end RCM discovery, stakeholder workshops, process mapping, requirements traceability and value-pool documentation.
• Build inventories of applications, interfaces, extracts, reports, macros/RPA, pain points and MVP backlog candidates.
• Prepare consulting artefacts, executive materials, roadmaps and structured handoff documentation across strategy and MVP workstreams.