Revenue Cycle Management; RCM Consultant - CarelonRx

Position: Revenue Cycle Management (RCM) Consultant - CarelonRx
Revenue Cycle Management (RCM) Consultant - Carelon Rx

(Financial Consultant)

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.

Carelon Rx is a proud member of the Elevance Health family of companies.

Carelon Rx 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 Consultant is a senior individual contributor responsible for establishing standard policies and procedures, advising on revenue cycle operating models, leading reengineering efforts, and identifying automation and transformation opportunities. This role brings broad and deep RCM expertise to help scale consistency, strengthen controls, and accelerate modernization across specialty and infusion pharmacy operations.

Key responsibilities

• Develop and maintain enterprise or function-level revenue cycle standards, policies, procedures, and governance practices to support consistent execution and compliance.
• Evaluate revenue cycle operations across teams and sites, identify structural improvement opportunities, and recommend reengineered workflows and operating models.
• Advise leaders on automation opportunities across eligibility, authorization, claim edits, denial prevention, appeals, payment posting, underpayment detection, and work queue routing.
• Lead complex cross-functional initiatives involving process standardization, technology enablement, performance management, and organizational change.
• Design rollout plans, audit-ready controls, KPI dashboards, and governance cadences to ensure improvements are sustained post-implementation.
• Serve as a subject matter expert for RCM best practices, payer rules, revenue leakage risk, and scalable operating design.

Minimum Requirements:

• Requires a BA/BS in accounting or finance and a minimum of 3 years experience in general accounting, finance, or budget and planning; or any combination of education and experience, which would provide an equivalent background. MBA, CPA, or CMA preferred.

Preferred qualifications

• In depth revenue cycle experience, in pharmacy preferred.
• Experience in consulting, shared services, multi-site healthcare, or enterprise transformation environments.
• Exposure to automation tools, workflow orchestration, analytics platforms, or AI-enabled RCM solutions.
• Experience supporting policy standardization and operational redesign across multiple business units or functions.

For candidates working in person or virtually in the below location(s), the salary range for this specific position is $74,960 to $112,440.

Locations:
Virginia

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as…