RCM Strategist

Saisystems Health • Shelton, CT

3d • Hybrid

About The Position

The RCM Strategist is a client-facing advisor within Saisystems Health's Consulting/Strategy umbrella, dedicated to helping provider organization clients optimize every stage of their revenue cycle — from charge capture and coding through claims adjudication, denial management, and accounts receivable recovery. This role delivers measurable financial improvement for clients by diagnosing operational gaps, implementing best-practice workflows, and translating RCM performance data into clear action plans.
Working alongside specialists in PacEHR, VBC/Quality, Payor Enrollment, and Compliance, the RCM Strategist serves as a trusted revenue cycle expert for a portfolio of clients — partnering closely with Account Managers to surface expansion opportunities and ensure clients are realizing the full value of their Saisystems Health engagement.

Requirements

• Bachelor's degree in Healthcare Administration, Finance, Business, or a related field — or equivalent professional experience.
• 5–8+ years of experience in healthcare revenue cycle management, medical billing, or healthcare financial operations.
• 3+ years in a client-facing, consulting, or advisory role within a healthcare services, managed services, or consulting organization.
• Deep working knowledge of the full revenue cycle — charge capture, coding, claims, payment posting, denial management, and AR collections.
• Experience with major practice management and billing systems (e.g., Athenahealth, eClinicalWorks, Epic, Greenway, Kareo) and clearinghouses.
• Familiarity with payer contract management, fee schedule analysis, and underpayment auditing.
• Strong command of ICD-10, CPT, and HCPCS coding conventions and CMS billing regulations across specialty and primary care settings.
• Excellent analytical and reporting skills — able to build and interpret RCM dashboards, surface root causes, and present findings to non-technical audiences.
• Strong client relationship management and executive communication skills; able to present clearly to a CFO and a billing specialist with equal effectiveness.
• Ability to manage multiple client engagements simultaneously, prioritize competing timelines, and deliver consistently under pressure.
• Consultative mindset — asks good questions, brings structured solutions, and holds clients accountable to improvement milestones.

Nice To Haves

• Coding certification (CPC, CCS, CCS-P, or equivalent) strongly preferred.

Responsibilities

• Serve as the primary revenue cycle consulting expert for clients, providing advisory support across billing, coding, claims submission, payment posting, denial management, and AR recovery.
• Conduct end-to-end RCM assessments to identify gaps in workflow, staffing, technology utilization, and payer contract performance — delivering prioritized improvement roadmaps with clear timelines and success metrics.
• Advise clients on ICD-10, CPT, and HCPCS coding accuracy, charge capture integrity, and clinical documentation improvement (CDI) strategies to minimize coding-related denials and underpayments.
• Guide clients in reducing days in AR, improving clean claim rates, and accelerating reimbursement cycles through operational changes and targeted payer engagement strategies.
• Support clients in building and managing denial management programs — including root cause analysis, appeal processes, payer escalations, and workflow redesign to prevent recurring denials.
• Develop and deliver RCM performance dashboards and operational reports tailored to client billing leadership and executive audiences, translating KPIs into actionable insights.
• Monitor key revenue cycle metrics across client portfolios — including first-pass resolution rate, denial rate, days in AR, net collection rate, and cost to collect — and provide structured recommendations for improvement.
• Conduct payer contract analysis to identify underpayment patterns, contract compliance issues, and opportunities for renegotiation or appeal.
• Lead periodic RCM performance reviews with client stakeholders, presenting findings, trends, and next-period priorities in a clear, executive-friendly format.
• Lead client-facing advisory sessions, quarterly business reviews, and strategic planning meetings with billing directors, CFOs, and practice administrators.
• Proactively communicate payer policy changes, CMS billing updates, coding guideline revisions, and regulatory developments that affect client revenue operations.
• Build and maintain strong relationships with client RCM teams, providing ongoing coaching, escalation support, and subject matter expertise between formal engagements.
• Partner with Account Managers to identify revenue cycle-related service expansion opportunities within existing client accounts.
• Collaborate with PacEHR and Payor Enrollment specialists on integrated engagements where RCM intersects with EHR configuration and provider credentialing.
• Contribute to the RCM practice's knowledge base by developing client-facing toolkits, billing process templates, coding reference guides, and best-practice playbooks.
• Support pre-sales and renewal conversations by contributing RCM expertise to proposals, RFP responses, and client presentations alongside the sales team.

Benefits

• Client improvement in days in AR, clean claim rate, and net collection rate vs. baseline
• Denial rate reduction and successful appeal rates across client portfolios
• Client satisfaction scores and retention in assigned accounts
• Timeliness and quality of client reporting deliverables
• Expansion revenue attributable to RCM practice referrals and recommendations
• SLA adherence across all active client engagements

What This Job Offers

• Job Type: Full-time
• Career Level: Senior