RCM SME Order-to-Cash (Revenue Cycle Management)

Position Title RCM SME Order-to-Cash (Revenue Cycle Management)

Location 10 Moore drive Durham Nc

Duration C2H

Job Description

RCM Functional SME Order-to-Cash (Laboratory Revenue Cycle Management)

2. Role Summary

The RCM Functional SME Order-to-Cash will assess and optimise the end-to-end laboratory revenue cycle, from order intake through cash realisation. The role will identify process gaps, revenue leakage, denial drivers, and data-quality issues while improving clean-claim rates, reimbursement outcomes, collections, and operational efficiency.

3. Key Responsibilities

• Lead the functional assessment of the complete laboratory Order-to-Cash lifecycle.
• Assess front-end workflows covering EHR/CPOE orders, demographics, eligibility, authorisation, and medical necessity.
• Evaluate coding, pricing, charge capture, claim submission, denial management, appeals, cash posting, and A/R processes.
• Identify upstream data-quality issues and root causes of payer edits, rejections, denials, delayed payments, and revenue leakage.
• Collaborate with business, laboratory, billing, payer, and IT stakeholders to define current-state gaps and improvement recommendations.

4. Required Skills & Experience

• 10+ years of experience in healthcare Revenue Cycle Management, with strong Order-to-Cash expertise.
• Deep functional knowledge of laboratory billing, claims, denials, appeals, cash posting, collections, and Accounts Receivable.
• Experience with EHR/CPOE, patient demographics, eligibility verification, prior authorisation, and medical necessity workflows.
• Proficiency in process assessment, gap analysis, root-cause analysis, workflow mapping, and revenue-leakage identification.
• Strong analytical, stakeholder-management, workshop-facilitation, requirements-documentation, and communication skills.

5. Preferred Skills

• Experience in laboratory diagnostics and Laboratory Information Systems (LIS).
• Knowledge of US healthcare payer rules, reimbursement models, coding, and compliance requirements.
• Experience with Epic, Oracle Health/Cerner, Meditech, or similar healthcare platforms.
• Exposure to revenue integrity, denial analytics, workflow automation, or AI-enabled RCM solutions.
• Good to have - Relevant certification in Revenue Cycle Management, healthcare operations, coding, Lean Six Sigma, or healthcare compliance.