Manager, Revenue Cycle - InRule Administration

Cardinal Health

10d•$89,000 - $114,480

About The Position

Revenue Cycle Management (RCM) is responsible for managing the financial lifecycle of patient accounts and ensuring timely and accurate payment for services provided. This job family is focused on a series of clinical and administrative processes that healthcare providers utilize to capture, bill, and collect patient service revenue in a manner that is compliant with payer rules and requirements. The revenue cycle shadows the entire patient care journey and begins with patient intake and ends when the patient’s account balance is zero. This team also encompasses a payer administration function that ensures we are successfully operationalizing payer rules and requirements as well as facilitating payer relations and escalation efforts. The Manager, Revenue Cycle – InRule Administration will serve as the hands-on owner of payer-specific business rules and decision logic within InRule, the rules engine that integrates with Brightree, across our DME businesses. This role will translate complex payer policies, coverage criteria, reimbursement requirements, and operational needs into accurate and scalable system rules and decision logic. The position will have primary responsibility for administering and optimizing InRule to ensure payer requirements are appropriately applied throughout end-to-end order to cash workflows with Brightree. This role operates within that governance framework and works closely with payer rules analysts, configuration specialists, and Revenue Cycle partners as a technical expert supporting the payer rules function at large.

Requirements

5+ years of hands-on experience in healthcare technology, payer configuration, business-rules administration, systems configuration, or a related technical function preferred.
Direct experience developing and administering a business-rules engine, decision-management platform, or comparable rules-based technology.
Demonstrated ability to independently author, debug, and optimize complex rules and decision logic without relying on an IT developer to perform the technical work.
Demonstrated ability to translate complex business requirements into technical rules and decision logic within a rules engine, along with the downstream system configuration needed to support them.
Experience with rule development/configuration, testing, debugging, deployment, version control, and production support.
Ability to troubleshoot rule execution, configuration defects, data dependencies, and system-processing issues.
Experience partnering with technical teams on system integrations, data flows, APIs/interfaces, or application configuration, including the data fluency (SQL or equivalent) to trace and validate the data feeding rules.
Strong understanding of healthcare payer policies, coverage requirements, reimbursement, and claims processes.

Nice To Haves

Bachelor's degree in related field, or equivalent work experience, preferred.
Experience with InRule strongly preferred, but comparable rules-engine or decision-management platform experience will be considered.
Brightree or other healthcare/DME platform experience preferred, particularly experience building rules or logic that integrate with such a platform rather than residing inside it.
Proven ability to operate as the technical expert within a larger team, influencing through expertise and collaboration rather than reporting lines.

Responsibilities

Serve as the technical owner and subject matter expert for the InRule environment, including rule authoring, decision logic, rule set design, testing, troubleshooting, deployment, and ongoing optimization of the rules engine supporting Brightree.
Translate complex payer policies, coverage criteria, reimbursement requirements, and operational needs into technical business rules and decision logic authored within InRule.
Independently develop, refactor, and tune rules, decision tables, and reusable rule components to keep the environment scalable and maintainable as payer complexity grows.
Apply and maintain the standards for rule development, testing, approval, deployment, version control, and change management established by the payer rules governance function and recommend improvements based on hands-on experience.
Perform impact analysis, testing, validation, and troubleshooting of rule and configuration changes prior to and following production deployment.
Maintain a centralized inventory of payer rules, configuration, dependencies, and changes to ensure accuracy and traceability.
Monitor rule performance and proactively identify configuration defects, conflicting logic, processing exceptions, and opportunities for optimization.
Partner with RCM and Payer Relations/Market Access to translate payer changes, denial trends, and operational findings into rule updates and related system changes.
Identify opportunities to prevent denials, unbilled revenue, and manual rework through improved rules configuration and automation.
Provide technical direction, design review, and coaching to analysts and configuration specialists within the payer rules team, without direct people-management responsibility.
Partner closely with IT and other technical stakeholders on the InRule–Brightree integration, data dependencies, environment management, releases, and production support.
Serve as the bridge between business requirements and the rules engine, ensuring requirements are translated into scalable and maintainable rule logic.
Support new payer implementations, acquisitions, integrations, and future-state system migrations.