Revenue Cycle Management (RCM) Consultant Senior - CarelonRx

Elevance Health•Tampa, FL

3d•Hybrid

About The Position

The Revenue Cycle Management (RCM) Consultant Senior is responsible for developing, maintaining, and interpreting revenue cycle reporting that helps leaders identify reimbursement risks, denial trends, cash acceleration opportunities, and operational performance gaps. This role turns large volumes of claims, billing, payer, and operational data into actionable insight for specialty and infusion pharmacy leaders.

Requirements

Requires a BA/BS in accounting or finance and a minimum of 5 years budgeting, forecasting and accounting financial reporting experience; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

Experience working with pharmacy, infusion, hospital, or provider-based billing data.
Experience with EHR, practice management, billing, or payer portal data sources.
Familiarity with revenue integrity, managed care, or reimbursement analytics.
Pharmacy revenue cycle experience highly desired.
MBA, CPA, CMA, FSA, and/or CFA preferred.

Responsibilities

Works with management to provide decision-support analysis, including revenue cycle performance insights across access, billing, denials, collections, reimbursement, and accounts receivable.
Conducts and documents complex financial and business analyses and research in areas including revenue realization, denial and underpayment trends, payer behavior, reimbursement timing (lag), write-offs, cash collections, and related performance drivers.
Builds, automates, and maintains recurring and ad hoc reports, dashboards, and scorecards; establishes reporting logic, data definitions, and metric standards to improve consistency and confidence in performance reporting.
Focuses on business improvement initiatives and leads projects by tracking and monitoring key KPIs (e.g., authorization cycle time, clean claim rate, denial rate, days in A/R, net collections, underpayments, and referral-to-start conversion) and identifying root causes and financial impact.
Partners with cross-functional teams (revenue cycle, operations, managed care, finance, and IT) to support decision-making and performance improvement initiatives; translates complex data into clear findings, recommendations, and leadership-ready materials.
Provides guidance to less experienced financial consultants/analysts on reporting methods, metric interpretation, and analysis approach.