Healthcare Technology Consulting - Revenue Cycle Architect

Job Family:

Technology Consulting

Travel Required:

Up to 50%

Clearance Required:

None

What You Will Do:

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. 

The Revenue Cycle Architect provides deep expertise across Oracle Health’s end-to-end revenue cycle ecosystem, including RevElate, legacy Cerner/Oracle RCM modules, EDI interfaces, financial workflows, and operational design.

The architect leads the translation of revenue cycle operations into system build, testing strategies, data/financial integrity models, and future-state operational workflows.

This role is not a cloud engineer, but must understand how OCI hosting impacts RevElate, EDI, claim flows, environment refresh cycles, and operational performance.

Key Responsibilities:

Revenue Cycle Domain Architecture

• Lead enterprise architecture across Patient Access, Revenue Integrity, Charge Services, Billing, Claims, PFS, HIM, and Financial Clearance.
• Translate revenue cycle operational requirements into system design, build standards, and workflow architecture.
• Define encounter models, charge logic pathways, claims and remittance flows, and cross-functional handoffs between clinical operations and revenue operations.
• Serve as the domain authority for RevElate’s account structure, workflow logic, reconciliation models, and operational implications.

RevElate Design & Optimization

Provide subject-matter leadership on RevElate—including:

• Account structure modeling
• Charge event logic
• Claim creation and submission rules
• Workqueues and staff workflows
• Conversion considerations (pre- and post-go-live)
• Translate legacy workflows into RevElate equivalents, identifying operational and financial risks.

Data Migration Leadership (Financial & Revenue Cycle)

Oversee the revenue cycle components of data migration, including:

• Encounter conversion
• Charge, payment, and adjustment data mapping
• Aged A/R strategy (what to convert vs. close out)
• Reconciliation models and validation rules
• Guide the financial integrity review cycles and defect remediation workflows.

Testing Strategy & Financial Integrity

Design comprehensive revenue cycle test plans that reflect:

• End-to-end operational flows
• Charge capture accuracy
• Payer-specific rules and CRD/accelerated edits
• Claims logic and denial scenario testing
• Reimbursement modeling, underpayment triggers, and audit checkpoints
• Partner with testing leadership to ensure scenarios cover complex payer mixes (Medicaid, Medicare, commercial, workers comp).

EDI, Integrations & Payer Connectivity

Oversee design and alignment across all revenue cycle-related interfaces:

• X12/EDI (837/835, 270/271, 278, attachments, secondary claims)
• Eligibility/authorization workflows
• Payer-specific nuance (Medicaid state rules, coverage carve-outs, program-specific edits)
• Ensure integration design supports real-time revenue cycle operations and financial performance.

Cutover & Go-Live Revenue Cycle Strategy

Lead the revenue cycle planning for cutover including:

• Encounter/account preparation
• Freeze logic for claims and charge processing
• Transitional workflows (split claims, shadow claims, manual reconciliation)
• Charge capture and clinical documentation dependencies
• Ensure stability in day 1–90 revenue operations and defect triage.

Applied OCI Knowledge (Not a Cloud Architect)

While not responsible for cloud design, must clearly understand how OCI impacts revenue cycle through:

• Environment provisioning and refresh cycles
• Integration latency and message throughput
• RevElate performance behaviors on OCI
• Downtime workflows and revenue cycle contingency planning
• EDI and clearinghouse connectivity pathways
• DR/BCP implications for billing, claims, authorizations, and front-end operations

Cross-Functional Leadership

• Collaborate with clinical, technical, integration, data migration, and operational leads to ensure cohesive, end-to-end design.
• Mentor analysts and builders working across revenue cycle domains.
• Establish governance standards and reusable patterns for the EHR CoE.

Client & Executive Communication

• Serve as a trusted advisor to CFOs, VPs of Revenue Cycle, PFS Directors, Clinical/Operational Leadership, and CIO/CTO partners.
• Communicate revenue cycle impacts and design decisions clearly, including risks and mitigation options.

What You Will Need:

• Bachelors degree

• 5+ years of Oracle Health revenue cycle experience, spanning multiple domains.
• Experience with RevElate—workflow logic, build, account structure, and operational impacts.
• Expertise in:
  • Revenue cycle architecture and future-state design
  • EDI/claim workflows and payer rules
  • Financial testing and reimbursement modeling
  • Data migration (financial/encounter data)
  • Cutover planning for revenue cycle operations
• Strong understanding of how OCI hosting affects revenue cycle performance.
• Ability to lead teams in complex, multi-vendor implementations.
• Strong grounding in hospital and ambulatory revenue cycle operations.

What Would Be Nice To Have:

• Experience with large-scale EHR modernization.
• Background with AMCs, IDNs, multi-hospital networks, or state agencies.
• Familiarity with CRD, coverage rules engines, authorization workflows, and Medicaid-specific requirements.
• Prior consulting experience.

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 RecruitingAccommodation@guidehouse.com. 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 guidehouse@myworkday.com.  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 recruiting@guidehouse.com. 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.