RCM Strategist

The RCM Strategist is a client-facing advisor within Saisystems Health's Consulting/Strategy umbrella, dedicated to helping provider organization clients optimize every stage of their revenue cycle — from charge capture and coding through claims adjudication, denial management, and accounts receivable recovery. This role delivers measurable financial improvement for clients by diagnosing operational gaps, implementing best-practice workflows, and translating RCM performance data into clear action plans.

Working alongside specialists in PacEHR, VBC/Quality, Payor Enrollment, and Compliance, the RCM Strategist serves as a trusted revenue cycle expert for a portfolio of clients — partnering closely with Account Managers to surface expansion opportunities and ensure clients are realizing the full value of their Saisystems Health engagement.

KEY RESPONSIBILITIES

Revenue Cycle Advisory

· Serve as the primary revenue cycle consulting expert for clients, providing advisory support across billing, coding, claims submission, payment posting, denial management, and AR recovery.

· Conduct end-to-end RCM assessments to identify gaps in workflow, staffing, technology utilization, and payer contract performance — delivering prioritized improvement roadmaps with clear timelines and success metrics.

· Advise clients on ICD-10, CPT, and HCPCS coding accuracy, charge capture integrity, and clinical documentation improvement (CDI) strategies to minimize coding-related denials and underpayments.

· Guide clients in reducing days in AR, improving clean claim rates, and accelerating reimbursement cycles through operational changes and targeted payer engagement strategies.

· Support clients in building and managing denial management programs — including root cause analysis, appeal processes, payer escalations, and workflow redesign to prevent recurring denials.

Performance Analytics & Reporting

· Develop and deliver RCM performance dashboards and operational reports tailored to client billing leadership and executive audiences, translating KPIs into actionable insights.

· Monitor key revenue cycle metrics across client portfolios — including first-pass resolution rate, denial rate, days in AR, net collection rate, and cost to collect — and provide structured recommendations for improvement.

· Conduct payer contract analysis to identify underpayment patterns, contract compliance issues, and opportunities for renegotiation or appeal.

· Lead periodic RCM performance reviews with client stakeholders, presenting findings, trends, and next-period priorities in a clear, executive-friendly format.

Client & Stakeholder Engagement

· Lead client-facing advisory sessions, quarterly business reviews, and strategic planning meetings with billing directors, CFOs, and practice administrators.

· Proactively communicate payer policy changes, CMS billing updates, coding guideline revisions, and regulatory developments that affect client revenue operations.

· Build and maintain strong relationships with client RCM teams, providing ongoing coaching, escalation support, and subject matter expertise between formal engagements.

Cross-Team Collaboration & Practice Growth

· Partner with Account Managers to identify revenue cycle-related service expansion opportunities within existing client accounts.

· Collaborate with PacEHR and Payor Enrollment specialists on integrated engagements where RCM intersects with EHR configuration and provider credentialing.

· Contribute to the RCM practice's knowledge base by developing client-facing toolkits, billing process templates, coding reference guides, and best-practice playbooks.

· Support pre-sales and renewal conversations by contributing RCM expertise to proposals, RFP responses, and client presentations alongside the sales team.

KEY PERFORMANCE INDICATORS

· Client improvement in days in AR, clean claim rate, and net collection rate vs. baseline

· Denial rate reduction and successful appeal rates across client portfolios

· Client satisfaction scores and retention in assigned accounts

· Timeliness and quality of client reporting deliverables

· Expansion revenue attributable to RCM practice referrals and recommendations

· SLA adherence across all active client engagements

QUALIFICATIONS

Education

· Bachelor's degree in Healthcare Administration, Finance, Business, or a related field — or equivalent professional experience.

· Coding certification (CPC, CCS, CCS-P, or equivalent) strongly preferred.

Experience

· 5–8+ years of experience in healthcare revenue cycle management, medical billing, or healthcare financial operations.

· 3+ years in a client-facing, consulting, or advisory role within a healthcare services, managed services, or consulting organization.

· Deep working knowledge of the full revenue cycle — charge capture, coding, claims, payment posting, denial management, and AR collections.

· Experience with major practice management and billing systems (e.g., Athenahealth, eClinicalWorks, Epic, Greenway, Kareo) and clearinghouses.

· Familiarity with payer contract management, fee schedule analysis, and underpayment auditing.

Skills & Competencies

· Strong command of ICD-10, CPT, and HCPCS coding conventions and CMS billing regulations across specialty and primary care settings.

· Excellent analytical and reporting skills — able to build and interpret RCM dashboards, surface root causes, and present findings to non-technical audiences.

· Strong client relationship management and executive communication skills; able to present clearly to a CFO and a billing specialist with equal effectiveness.

· Ability to manage multiple client engagements simultaneously, prioritize competing timelines, and deliver consistently under pressure.

· Consultative mindset — asks good questions, brings structured solutions, and holds clients accountable to improvement milestones.

WORK ENVIRONMENT

This is a Hybrid role with regular client-facing engagements including on-site visits, quarterly business reviews, and occasional team gatherings. You will operate as part of the Saisystems Health Customer Success Consulting Practice, collaborating daily with Account Managers, fellow practice strategists, and the Director of Customer Success.

ORGANIZATIONAL RELATIONSHIPS

This role develops and maintains strong working relationships with:

· Director of Customer Success and Consulting Practice leadership

· Account Management team — for client expansion and escalation coordination

· Fellow Consulting Practice specialists (PacEHR, VBC/Quality, Payor Enrollment, CMP)

· Client billing directors, CFOs, and practice administrators

· Payer representatives and clearinghouse contacts (on behalf of clients)

· Sales team — for pre-sales support and new engagement scoping