Convergenz
Position Summary
The Oracle Revenue Cycle Management Workstream Lead 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
This ensures the architect can anticipate issues and make aligned design recommendations.
* 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.
Required Qualifications
* 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.
Preferred Qualifications
* 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 Oracle Revenue Cycle Management Workstream Lead 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
This ensures the architect can anticipate issues and make aligned design recommendations.
* 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.
Required Qualifications
* 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.
Preferred Qualifications
* 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.