Senior Revenue Cycle Management Consultant – CarelonRx

Role Overview

• Responsible for developing, maintaining, and interpreting revenue cycle reporting that helps leaders identify reimbursement risks, denial trends, cash acceleration opportunities, and operational performance gaps
• Turns large volumes of claims, billing, payer, and operational data into actionable insight for specialty and infusion pharmacy leaders
• 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 identifies 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

Requirements

• Requires a BA/BS in accounting or finance
• Minimum of 5 years budgeting, forecasting and accounting financial reporting experience; or any combination of education and experience, which would provide an equivalent background
• Experience working with pharmacy, infusion, hospital, or provider-based billing data preferred
• Experience with EHR, practice management, billing, or payer portal data sources preferred
• Familiarity with revenue integrity, managed care, or reimbursement analytics preferred
• Pharmacy revenue cycle experience highly desired
• MBA, CPA, CMA, FSA, and/or CFA preferred

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs (unless covered by a collective bargaining agreement)
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources