Healthcare Technology Consulting - Revenue Cycle Architect

Guidehouse•Boston, MA

2d•$130,000 - $216,000

About The Position

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.

Requirements

Bachelors degree
5+ years of Oracle Health revenue cycle experience , spanning multiple domains.
Experience with RevElate —workflow logic, build, account structure, and operational impacts.
Expertise in: Revenue cycle architecture and future-state design EDI/claim workflows and payer rules Financial testing and reimbursement modeling Data migration (financial/encounter data) Cutover planning for revenue cycle operations
Strong understanding of how OCI hosting affects revenue cycle performance .
Ability to lead teams in complex, multi-vendor implementations.
Strong grounding in hospital and ambulatory revenue cycle operations.

Nice To Haves

Experience with large-scale EHR modernization.
Background with AMCs, IDNs, multi-hospital networks, or state agencies.
Familiarity with CRD, coverage rules engines, authorization workflows, and Medicaid-specific requirements.
Prior consulting experience.

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-end design.
Mentor analysts and builders working across revenue cycle domains.
Establish governance standards and reusable patterns for the EHR CoE.
Client & Executive Communication Serve as a trusted advisor to CFOs, VPs of Revenue Cycle, PFS Directors, Clinical/Operational Leadership, and CIO/CTO partners.
Communicate revenue cycle impacts and design decisions clearly, including risks and mitigation options.

Benefits

Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave and Adoption Assistance
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Student Loan PayDown
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program
Mobility Stipend