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Divurgent · 1 day ago

Oracle Health/Cerner Revenue Cycle Management Workstream Project Manager (Contract to Hire)

Boston, MA

Contract

Hybrid

Senior Level

5+ years exp

Divurgent is a solutions provider focused on healthcare consulting, and they are seeking an Oracle Health/Cerner Revenue Cycle Management Workstream Project Manager. This role requires expertise in revenue cycle operations, leading architecture and design, and ensuring effective data migration and testing strategies within the Oracle Health ecosystem.

ConsultingHealth CareInformation TechnologyLegal

No H1B

Hiring Manager

Pat Munday

Responsibilities

Lead enterprise architecture across Patient Access, Revenue Integrity, Charge Services, Billing, Claims, PFS, HIM, and Financial Clearance

Translate revenue cycle operational requirements into system design, build standards, and workflow architecture

Define encounter models, charge logic pathways, claims and remittance flows, and cross-functional handoffs between clinical operations and revenue operations

Serve as the domain authority for RevElate’s account structure, workflow logic, reconciliation models, and operational implications

Provide Subject-matter Leadership On RevElate—including account structure modeling, charge event logic, claim creation and submission rules, workqueues and staff workflows, conversion considerations (pre- and post-go-live)

Translate legacy workflows into RevElate equivalents, identifying operational and financial risks

Oversee The Revenue Cycle Components Of Data Migration, Including encounter conversion, charge, payment, and adjustment data mapping, aged A/R strategy (what to convert vs. close out), reconciliation models and validation rules

Guide the financial integrity review cycles and defect remediation workflows

Design Comprehensive Revenue Cycle Test Plans That Reflect end-to-end operational flows, charge capture accuracy, payer-specific rules and CRD/accelerated edits, claims logic and denial scenario testing, reimbursement modeling, underpayment triggers, and audit checkpoints

Partner with testing leadership to ensure scenarios cover complex payer mixes (Medicaid, Medicare, commercial, workers comp)

Oversee Design And Alignment Across All Revenue Cycle-related Interfaces including X12/EDI (837/835, 270/271, 278, attachments, secondary claims), eligibility/authorization workflows, payer-specific nuance (Medicaid state rules, coverage carve-outs, program-specific edits)

Ensure integration design supports real-time revenue cycle operations and financial performance

Lead The Revenue Cycle Planning For Cutover Including encounter/account preparation, freeze logic for claims and charge processing, transitional workflows (split claims, shadow claims, manual reconciliation), charge capture and clinical documentation dependencies

Ensure stability in day 1–90 revenue operations and defect triage

While not responsible for cloud design, must clearly understand how OCI impacts revenue cycle through environment provisioning and refresh cycles, integration latency and message throughput, RevElate performance behaviors on OCI, downtime workflows and revenue cycle contingency planning, EDI and clearinghouse connectivity pathways, DR/BCP implications for billing, claims, authorizations, and front-end operations

Collaborate with clinical, technical, integration, data migration, and operational leads to ensure cohesive, end-to-end design

Mentor analysts and builders working across revenue cycle domains

Establish governance standards and reusable patterns for the EHR CoE

Serve as a trusted advisor to CFOs, VPs of Revenue Cycle, Directors, Clinical/Operational Leadership, and CIO/CTO partners

Communicate revenue cycle impacts and design decisions clearly, including risks and mitigation options

Qualification

Oracle Health implementationRevElate expertiseRevenue cycle architectureData migration leadershipEDI workflowsFinancial testingCutover planningMulti-vendor implementationClient communicationCross-functional leadership