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Revenue Cycle Management (RCM) Consultant Senior - CarelonRx

Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

CarelonRx is a proud member of the Elevance Health family of companies. CarelonRx pairs a strong, clinical-first lens with deep pharmacy expertise to create solutions that improve outcomes, control costs, and enhance each member's health.

The Revenue Cycle Management (RCM) Consultant Senior is responsible for developing, maintaining, and interpreting revenue cycle reporting that helps leaders identify reimbursement risks, denial trends, cash acceleration opportunities, and operational performance gaps. This role turns large volumes of claims, billing, payer, and operational data into actionable insight for specialty and infusion pharmacy leaders.

Key responsibilities:

• Works with management to provide decision-support analysis, including revenue cycle performance insights across access, billing, denials, collections, reimbursement, and accounts receivable.
• Conducts and documents complex financial and business analyses and researchin areas including revenue realization, denial and underpayment trends, payer behavior, reimbursement timing (lag), write-offs, cash collections, and related performance drivers.
• Builds, automates, and maintains recurring and ad hoc reports, dashboards, and scorecards; establishes reporting logic, data definitions, and metric standards to improve consistency and confidence in performance reporting.
• Focuses on business improvement initiatives and leads projectsby tracking and monitoring key KPIs (e.g., authorization cycle time, clean claim rate, denial rate, days in A/R, net collections, underpayments, and referral-to-start conversion) and identifying root causes and financial impact.
• Partners with cross-functional teams(revenue cycle, operations, managed care, finance, and IT) to support decision-making and performance improvement initiatives; translates complex data into clear findings, recommendations, and leadership-ready materials.
• Provides guidance to less experienced financial consultants/analystson reporting methods, metric interpretation, and analysis approach.

Minimum Requirements:

• Requires a BA/BS in accounting or finance and a minimum of 5 years budgeting, forecasting and accounting financial reporting experience; or any combination of education and experience, which would provide an equivalent background.

Preferred qualifications

• Experience working with pharmacy, infusion, hospital, or provider-based billing data.
• Experience with EHR, practice management, billing, or payer portal data sources.
• Familiarity with revenue integrity, managed care, or reimbursement analytics.
• Pharmacy revenue cycle experience highly desired.
• MBA, CPA, CMA, FSA, and/or CFA preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.