Digital Sol. Architect Senior Director

Overview

We are seeking a Revenue Cycle Management (RCM) Domain Architect with deep expertise across patient access, coding, billing, collections, and payer operations. In this role, you will architect end-to-end AI-native RCM process solutions that modernize traditional provider workflows into intelligent, autonomous, agent-driven systems. You will partner with clinical operations leaders, RCM executives, and engineering teams to map complex revenue cycle processes and define scalable future-state architectures.

Key Responsibilities

Revenue Cycle Domain Architecture

• Lead architecture and design for end-to-end provider RCM, including:
• Patient access & scheduling
• Eligibility & prior authorization
• Charge capture & clinical documentation integrity
• Coding (pro-fee, facility, specialty)
• Billing, claims processing, and submission
• Denials prevention and denials management
• Payment posting & reconciliation
• Patient financial engagement & collections
• Translate compliance, regulatory, and payer requirements (HIPAA, CMS guidelines, coding standards) into scalable AI-driven workflows.
• Develop reusable domain models and frameworks for provider, ASC, specialty care, and hospital revenue cycle operations.
  
  

AI-Native BPS / BPaaS Design

• Architect modular, agentic RCM solutions using LLM-based co-pilots, autonomous denial agents, and decision-support services.
• Collaborate with ML, engineering, and ontology teams to define RCM ontologies, data structures, and decision models (e.g., coding logic, payer rule libraries, denial taxonomies).
• Design closed-loop systems for continuous optimization across claims, payments, and workflow routing.
  
  

Client Engagement & Delivery

• Lead discovery sessions with provider organizations, health systems, and RCM leadership to map current-state operations and identify inefficiencies.
• Present AI-native RCM architectures and transformation roadmaps to CFOs, Revenue Cycle VPs, HIM leaders, and clinical operations stakeholders.
• Own the translation of RCM domain requirements into platform capabilities and implementation plans.
  
  

Strategic Roadmapping

• Build multi-year modernization strategies that connect operational KPIs—DNFB, clean claim rate, A/R days, denial rate, cost-to-collect—to automation roadmaps.
• Support clients in adopting new AI-native operating models, including governance, escalation design, exception handling, and agent orchestration.
  
  

Required Skills & Experience

• 10+ years of experience in healthcare revenue cycle, consulting, or RCM operations.
• Deep understanding of provider RCM processes across patient access, coding, billing, denials, payment posting, and collections.
• Experience designing RCM architectures, target operating models, or digital transformation roadmaps for provider organizations.
• Strong knowledge of payer rules, CMS policies, coding standards (ICD-10, CPT, HCPCS), and compliance requirements.
• Familiarity with AI/ML workflows, LLM-driven automation, and digital RCM solutions (even if not hands-on technical).
• Strong storytelling and client engagement skills, especially with executive healthcare stakeholders.
• Ability to partner with engineering and product teams to translate domain requirements into platform features.
  
  

Preferred Qualifications

• Experience with major EHR/RCM platforms including Epic (Resolute), Cerner/Oracle, Meditech, Athenahealth, NextGen, or eClinicalWorks.
• Knowledge of payer workflows, value-based care, and contract management.
• Understanding of RCM analytics, predictive denials, NLP-driven coding, and rules engines.
• Familiarity with HIM operations, CDI, and clinical documentation standards.
• Experience in hospital, health system, ambulatory, or multi-specialty group RCM environments.