Revenue Cycle Management (RCM) Functional Lead

Job Family Technology Consulting Travel Required Up to 50% Clearance Required None Guidehouse’s Health IT Solutions team works with clients to measurably improve their technology outcomes through a mix of IT strategies, improvement in IT operations, and adoption of technology initiatives. By leveraging a deep understanding of health system IT operational best practices supported by data, Guidehouse propels IT operational improvement and technology adoption across departments and service lines at client organizations.

What You Will Do

The Technical Healthcare Revenue Cycle Lead will oversee the design, configuration, validation, and deployment of an ERP solution across the entirety of a health system for a public client . This role requires deep expertise in public sector healthcare billing, including long-term care, behavioral health, and pharmacy operations. The Lead will serve as the primary liaison between the Revenue Cycle Advisory Council, client health teams, and stakeholders, ensuring that the solution meets the client's complex financial, regulatory, and operational requirements.

Key Responsibilities

• Revenue Cycle Design and Configuration
• Lead the functional design and configuration of ERP solutions, ensuring alignment with client billing workflows, including long-stay inpatient billing, trust account management, and pharmacy claims
• Develop and validate workflows for interim monthly billing, Medicare Part D, Medicaid eligibility, and resident trust accounts
• Oversee the upload and validation of the Charge Description Master (CDM), ensuring CPT/HCPCS code alignment with procedures and services
• Collaborate with the Patient Accounting and Practice Management teams to configure registration, scheduling, and eligibility workflows
• Design and validate EMRN/MRN strategies to support cross-agency patient identity management
• Ensure compliance with federal and state clients, CMS and HFMA MAP standards for billing, reimbursement, and financial reporting
• State-Specific Revenue Cycle Requirements
• Translate client-specific billing needs into system requirements, including:
• Long-term care billing cycles and interim claims
• Resident trust account workflows, including deposits, withdrawals, and reconciliation
• Federal/state community services billing, including vendor-submitted claims and EIM system integration.
• Service authorization workflows and capacity management for behavioral health services
• Integrations for financial tracking and reporting
• Collaborate with state finance and compliance teams to ensure accurate grant and funding reports for state and federal programs.
• Testing and Validation
• Lead parallel revenue cycle testing, reconciling results with legacy MEDITECH systems
• Validate charge capture, claims generation, eligibility verification, and electronic remittance advice (ERA) posting
• Ensure readiness for day-one revenue cycle operations, including cash flow continuity and billing compliance
• Collaborate with Testing Lead and Data Migration Lead to validate financial data accuracy and integrity
• Stakeholder Engagement and Governance
• Serve as the primary point of contact for revenue cycle stakeholders, including the Revenue Cycle Advisory Council, billing teams, HIM, and finance leadership
• Participate in Change Control Board (CCB) and Steering Committee meetings to evaluate financial impacts of scope changes
• Provide executive-level reporting on revenue cycle readiness, risk posture, and performance metrics
• Facilitate workshops and design sessions with state agencies to gather requirements and validate workflows

What You Will Need

• Bachelors Degree
• Minimum 5 years of leadership experience in healthcare revenue cycle operations roles
• Proven experience implementing Oracle Health RevElate in public sector or complex payer environments.
• Deep understanding of State and Federal billing requirements, including long-stay inpatient billing, trust accounts, and behavioral health reimbursement
• Experience with HFMA MAP standards and other industry-recognized revenue cycle frameworks
• Familiarity with Medicaid, Medicare Part D, and state-specific billing systems
• Strong knowledge of CDM management, charge capture workflows, and denial prevention strategies
• Excellent communication, stakeholder engagement, and documentation skills

What Would Be Nice To Have

• HFMA certification or equivalent credential
• Experience with federal/state EHR implementation projects
• Familiarity with Oracle Health Data Intelligence (formerly HealtheIntent) for financial analytics and reporting
• Experience with behavioral health and long-term care billing workflows, including 42 CFR Part 2 compliance
• Experience managing revenue cycle transformation in multi-entity, multi-payer environments

The annual salary range for this position is $130,000.00-$216,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits

Include

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave and Adoption Assistance
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Student Loan PayDown
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program
• Mobility Stipend

About Guidehouse Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or [email protected]. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process. If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact [email protected]. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties. Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee. Apply tot his job Apply To this Job