Revenue Cycle Management (RCM) Consultant - CarelonRx

Elevance Health•Ashburn, OH

1d•Hybrid

About The Position

The Revenue Cycle Consultant is a senior individual contributor responsible for establishing standard policies and procedures, advising on revenue cycle operating models, leading reengineering efforts, and identifying automation and transformation opportunities. This role brings broad and deep RCM expertise to help scale consistency, strengthen controls, and accelerate modernization across specialty and infusion pharmacy operations.

Requirements

In depth revenue cycle experience, in pharmacy preferred.
Experience in consulting, shared services, multi-site healthcare, or enterprise transformation environments.
Exposure to automation tools, workflow orchestration, analytics platforms, or AI-enabled RCM solutions.
Experience supporting policy standardization and operational redesign across multiple business units or functions.

Responsibilities

Develop and maintain enterprise or function-level revenue cycle standards, policies, procedures, and governance practices to support consistent execution and compliance.
Evaluate revenue cycle operations across teams and sites, identify structural improvement opportunities, and recommend reengineered workflows and operating models.
Advise leaders on automation opportunities across eligibility, authorization, claim edits, denial prevention, appeals, payment posting, underpayment detection, and work queue routing.
Lead complex cross-functional initiatives involving process standardization, technology enablement, performance management, and organizational change.
Design rollout plans, audit-ready controls, KPI dashboards, and governance cadences to ensure improvements are sustained post-implementation.
Serve as a subject matter expert for RCM best practices, payer rules, revenue leakage risk, and scalable operating design.