RCM

Role & responsibilities

Requirements Gathering

• Engage with RCM stakeholders (operations, compliance, technology) to gather and document detailed business requirements across intake, coding, billing, claims, A/R, and denials.
• Define user stories, business rules, data flows, and system behavior aligned with operational outcomes.
• Work closely with product managers to prioritize features based on business value and technical feasibility.

Subject Matter Expertise (SME)

• Provide domain expertise in U.S. healthcare revenue cycle processes and technologies.
• Offer field-level insights from front-end intake through back-end collections and appeals.
• Advise on industry best practices, compliance considerations, and emerging trends in automation and AI adoption in RCM.

Techno-Functional Collaboration

• Act as a liaison between business users and development teams to ensure solution design aligns with functional needs.
• Partner with architects and engineers on data modeling, workflow engines, and AI/ML model integration.
• Participate in user acceptance testing (UAT), validating system outputs against business expectations.

Platform Innovation

• Contribute to platform design and modularization of features such as (but not limited to):

• Claims Automation

  (e.g., OCR, NLP, intelligent form capture)

• Autonomous Coding

  (ICD/CPT code prediction using AI/ML)

• Process Optimization

  (clearinghouse logic, eligibility validation)

• Denials Prevention & Prediction

  (ML-based denial scoring, root cause analytics)
• Identify opportunities for AI/automation to enhance accuracy, reduce TAT, and minimize human intervention.

Documentation & Change Management

• Develop clear documentation including BRDs, FRDs, process maps, and data dictionaries.
• Support training, change management, and knowledge transfer to internal teams and client stakeholders.

Preferred candidate profile

• Bachelors degree in Healthcare Administration, Information Systems, Computer Science, or related field.
• 10+ years of experience in RCM operations, product development, or business analysis, preferably in a healthcare technology or BPO setting.
• Deep understanding of end-to-end RCM workflows and pain points.
• Experience working with or designing solutions involving automation, RPA, AI/ML, and data analytics.
• Familiarity with RCM platforms, EHRs (e.g., Epic, Cerner, Athena), and clearinghouse integrations.

• Experience with product development lifecycles (Agile, Scrum).
• Experience in working with wide range of practice management systems used by providers in the US
• Data sourcing and integration experience with leading EHR/EMR, clearing houses and payer claims systems
• Proficiency in tools such as JIRA, Confluence, Lucidchart/Visio, SQL.
• Exposure to technologies like OCR, NLP, RPA (UiPath, Automation Anywhere), and machine learning models.
• Certifications in Business Analysis (CBAP/CCBA), Healthcare IT (e.g., CPHIMS), or Lean/Six Sigma.