Revenue Cycle Management (RCM) Consultant Senior - CarelonRx

Revenue Cycle Management (RCM) Consultant Senior - CarelonRx

Revenue Cycle Management (RCM) Consultant Senior – CarelonRx

Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

CarelonRx is a proud member of the Elevance Health family of companies. CarelonRx pairs a strong, clinical-first lens with deep pharmacy expertise to create solutions that improve outcomes, control costs, and enhance each member's health.

The Revenue Cycle Management (RCM) Consultant Senior is responsible for developing, maintaining, and interpreting revenue cycle reporting that helps leaders identify reimbursement risks, denial trends, cash acceleration opportunities, and operational performance gaps. This role turns large volumes of claims, billing, payer, and operational data into actionable insight for specialty and infusion pharmacy leaders.

Key responsibilities:

• Works with management to provide decision-support analysis, including revenue cycle performance insights across access, billing, denials, collections, reimbursement, and accounts receivable.
• Conducts and documents complex financial and business analyses and research in areas including revenue realization, denial and underpayment trends, payer behavior, reimbursement timing (lag), write-offs, cash collections, and related performance drivers.
• Builds, automates, and maintains recurring and ad hoc reports, dashboards, and scorecards; establishes reporting logic, data definitions, and metric standards to improve consistency and confidence in performance reporting.
• Focuses on business improvement initiatives and leads projects by tracking and monitoring key KPIs (e.g., authorization cycle time, clean claim rate, denial rate, days in A/R, net collections, underpayments, and referral-to-start conversion) and identifying root causes and financial impact.
• Partners with cross-functional teams (revenue cycle, operations, managed care, finance, and IT) to support decision-making and performance improvement initiatives; translates complex data into clear findings, recommendations, and leadership-ready materials.
• Provides guidance to less experienced financial consultants/analysts on reporting methods, metric interpretation, and analysis approach.

Minimum Requirements:

• Requires a BA/BS in accounting or finance and a minimum of 5 years budgeting, forecasting and accounting financial reporting experience; or any combination of education and experience, which would provide an equivalent background.

Preferred qualifications

• Experience working with pharmacy, infusion, hospital, or provider-based billing data.
• Experience with EHR, practice management, billing, or payer portal data sources.
• Familiarity with revenue integrity, managed care, or reimbursement analytics.
• Pharmacy revenue cycle experience highly desired.
• MBA, CPA, CMA, FSA, and/or CFA preferred.

Job Level: Non-Management Exempt

Workshift: 1st Shift (United States of America)

Job Family: AFA > Financial Reporting, Planning & Analysis