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Revenue Cycle Management (RCM) Domain Architect

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NTT DATA

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Location:
United States , Plano

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Category:
IT - Software Development

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Contract Type:
Not provided

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Salary:

Not provided
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Job Description:

The Senior Director, Digital Solutions Architect will lead the design and implementation of AI-native revenue cycle management solutions in healthcare. This role requires over 10 years of experience in RCM processes, strong knowledge of compliance requirements, and the ability to engage with executive stakeholders. The position offers a hybrid work environment and the opportunity to drive significant transformation in the industry.

Job Responsibility:

  • Lead architecture and design for end-to-end provider RCM, including: Patient access & scheduling, Eligibility & prior authorization, Charge capture & clinical documentation integrity, Coding (pro-fee, facility, specialty), Billing, claims processing, and submission, Denials prevention and denials management, Payment posting & reconciliation, Patient financial engagement & collections
  • Translate compliance, regulatory, and payer requirements (HIPAA, CMS guidelines, coding standards) into scalable AI-driven workflows
  • Develop reusable domain models and frameworks for provider, ASC, specialty care, and hospital revenue cycle operations
  • Architect modular, agentic RCM solutions using LLM-based co-pilots, autonomous denial agents, and decision-support services
  • Collaborate with ML, engineering, and ontology teams to define RCM ontologies, data structures, and decision models (e.g., coding logic, payer rule libraries, denial taxonomies)
  • Design closed-loop systems for continuous optimization across claims, payments, and workflow routing
  • Lead discovery sessions with provider organizations, health systems, and RCM leadership to map current-state operations and identify inefficiencies
  • Present AI-native RCM architectures and transformation roadmaps to CFOs, Revenue Cycle VPs, HIM leaders, and clinical operations stakeholders
  • Own the translation of RCM domain requirements into platform capabilities and implementation plans
  • Build multi-year modernization strategies that connect operational KPIs—DNFB, clean claim rate, A/R days, denial rate, cost-to-collect—to automation roadmaps
  • Support clients in adopting new AI-native operating models, including governance, escalation design, exception handling, and agent orchestration

Requirements:

  • 10+ years of experience in healthcare revenue cycle, consulting, or RCM operations
  • Deep understanding of provider RCM processes across patient access, coding, billing, denials, payment posting, and collections
  • Experience designing RCM architectures, target operating models, or digital transformation roadmaps for provider organizations
  • Strong knowledge of payer rules, CMS policies, coding standards (ICD-10, CPT, HCPCS), and compliance requirements
  • Familiarity with AI/ML workflows, LLM-driven automation, and digital RCM solutions (even if not hands-on technical)
  • Strong storytelling and client engagement skills, especially with executive healthcare stakeholders
  • Ability to partner with engineering and product teams to translate domain requirements into platform features

Nice to have:

  • Experience with major EHR/RCM platforms including Epic (Resolute), Cerner/Oracle, Meditech, Athenahealth, NextGen, or eClinicalWorks
  • Knowledge of payer workflows, value-based care, and contract management
  • Understanding of RCM analytics, predictive denials, NLP-driven coding, and rules engines
  • Familiarity with HIM operations, CDI, and clinical documentation standards
  • Experience in hospital, health system, ambulatory, or multi-specialty group RCM environments

Additional Information:

Job Posted:
March 19, 2026

Employment Type:
Fulltime
Work Type:
Hybrid work
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