Revenue Cycle Management Solutions Architect

Company Overview: Our client is an industry leader at the intersection of FinTech and HealthTech, specializing in leveraging advanced technologies like artificial intelligence (AI) and robotic process automation (RPA) to optimize revenue cycle management (RCM) processes for healthcare organizations. With a focus on enhancing operational efficiency, reducing costs, and improving patient care, the client provides tailored solutions to meet the unique challenges of modern healthcare systems. Position Summary: The Revenue Cycle Management (RCM) Solutions Architect will be responsible for designing and implementing cutting-edge technology solutions that streamline and optimize healthcare revenue cycle processes. This role requires extensive expertise in healthcare systems, APIs, and automation technologies, as well as a strong understanding of financial and operational challenges in the healthcare industry. Key Responsibilities: Solution Design: Architect and implement advanced RCM solutions leveraging AI, RPA, and machine learning technologies to enhance operational efficiency. Customize automation deliverables based on specific client goals to improve financial margins, physician satisfaction, and patient outcomes. Systems Integration: Lead integration efforts involving healthcare APIs such as HL7, FHIR, EDI 837/835, and ERP systems like Epic, Cerner, and Athenahealth. Collaborate with IT and RCM teams to ensure seamless data exchange across systems. Automation and Optimization: Drive automation in claims processing, eligibility verification, payment posting, and denial management. Identify opportunities to reduce manual interventions by 70% and improve data accuracy by 99%. Data Analytics and Reporting: Utilize predictive analytics and BI tools to provide insights into RCM performance, financial outcomes, and operational efficiency. Develop dashboards for tracking claims lifecycle, payment trends, and A/R performance. Compliance and Security: Ensure adherence to healthcare standards such as HIPAA, SOC 1, SOC 2, and PCI. Implement advanced cybersecurity protocols to protect sensitive patient and financial data. Stakeholder Collaboration: Partner with internal teams and external stakeholders, including payers, providers, and clearinghouses, to design scalable and robust RCM solutions. Provide strategic input on telehealth and EHR digitization initiatives. Qualifications: Education: Bachelor’s or Master’s degree in Information Technology, Healthcare Administration, Computer Science, or related fields. Equivalent professional experience may be considered. Experience: 7+ years in healthcare RCM, IT, or EDI system architecture, with a focus on automation and systems integration. Demonstrated expertise in handling large-scale EDI transactions, including 837 (claims), 835 (remittance), and 270/271 (eligibility). Proven success in implementing AI-driven solutions for RCM workflows. Skills: Proficient in healthcare APIs (HL7, FHIR, EDI 837/835). Strong understanding of automation tools (e.g., RPA, AI platforms) and ERP systems. Exceptional analytical skills to interpret complex data and deliver actionable insights. Leadership and project management experience in healthcare technology implementations. Strong communication and interpersonal skills to collaborate with technical and non-technical teams. Preferred Qualifications: Experience with cloud platforms and containerization technologies (Azure, Docker, Kubernetes). Familiarity with telehealth solutions and EHR digitization. Knowledge of advanced analytics and visualization tools for healthcare RCM.