Domain RCM Functional SME – Order-to-Cash

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.