Domain RCM Functional SME - Order-to-Cash

Job Description

Domain RCM Functional SME – Order-to-Cash

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Location : Durham NC (Hybrid)

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Job Title

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RCM Functional SME – Order-to-Cash (Laboratory Revenue Cycle Management)

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2. Role Summary

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The RCM Functional SME – Order-to-Cash will assess and optimise the end-to-end laboratory revenue cycle, from order intake through cash realisation. The role will identify process gaps, revenue leakage, denial drivers, and data-quality issues while improving clean-claim rates, reimbursement outcomes, collections, and operational efficiency.

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3. Key Responsibilities

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Lead the functional assessment of the complete laboratory Order-to-Cash lifecycle.

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Assess front-end workflows covering EHR/CPOE orders, demographics, eligibility, authorisation, and medical necessity.

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Evaluate coding, pricing, charge capture, claim submission, denial management, appeals, cash posting, and A/R processes.

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Identify upstream data-quality issues and root causes of payer edits, rejections, denials, delayed payments, and revenue leakage.

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Collaborate with business, laboratory, billing, payer, and IT stakeholders to define current-state gaps and improvement recommendations.

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4. Required Skills & Experience

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10+ years of experience in healthcare Revenue Cycle Management, with strong Order-to-Cash expertise.

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Deep functional knowledge of laboratory billing, claims, denials, appeals, cash posting, collections, and Accounts Receivable.

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Experience with EHR/CPOE, patient demographics, eligibility verification, prior authorisation, and medical necessity workflows.

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Proficiency in process assessment, gap analysis, root-cause analysis, workflow mapping, and revenue-leakage identification.

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Strong analytical, stakeholder-management, workshop-facilitation, requirements-documentation, and communication skills.

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5. Preferred Skills

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Experience in laboratory diagnostics and Laboratory Information Systems (LIS).

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Knowledge of US healthcare payer rules, reimbursement models, coding, and compliance requirements.

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Experience with Epic, Oracle Health/Cerner, Meditech, or similar healthcare platforms.

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Exposure to revenue integrity, denial analytics, workflow automation, or AI-enabled RCM solutions.

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Good to have - Relevant certification in Revenue Cycle Management, healthcare operations, coding, Lean Six Sigma, or healthcare compliance.