What Revenue Cycle Management (RCM) contributes to Cardinal Health
Revenue Cycle Management (RCM) is responsible for managing the financial lifecycle of patient accounts and ensuring timely and accurate payment for services provided. This job family is focused on a series of clinical and administrative processes that healthcare providers utilize to capture, bill, and collect patient service revenue in a manner that is compliant with payer rules and requirements. The revenue cycle shadows the entire patient care journey and begins with patient intake and ends when the patient’s account balance is zero. This team also encompasses a payer administration function that ensures we are successfully operationalizing payer rules and requirements as well as facilitating payer relations and escalation efforts.
Job Summary
The Manager, Revenue Cycle – InRule Administration will serve as the hands-on owner of payer-specific business rules and decision logic within InRule, the rules engine that integrates with Brightree, across our DME businesses.
This role will translate complex payer policies, coverage criteria, reimbursement requirements, and operational needs into accurate and scalable system rules and decision logic. The position will have primary responsibility for administering and optimizing InRule to ensure payer requirements are appropriately applied throughout end-to-end order to cash workflows with Brightree. This role operates within that governance framework and works closely with payer rules analysts, configuration specialists, and Revenue Cycle partners as a technical expert supporting the payer rules function at large.
Responsibilities
Serve as the technical owner and subject matter expert for the InRule environment, including rule authoring, decision logic, rule set design, testing, troubleshooting, deployment, and ongoing optimization of the rules engine supporting Brightree.
Translate complex payer policies, coverage criteria, reimbursement requirements, and operational needs into technical business rules and decision logic authored within InRule.
Independently develop, refactor, and tune rules, decision tables, and reusable rule components to keep the environment scalable and maintainable as payer complexity grows.
Apply and maintain the standards for rule development, testing, approval, deployment, version control, and change management established by the payer rules governance function and recommend improvements based on hands-on experience.
Perform impact analysis, testing, validation, and troubleshooting of rule and configuration changes prior to and following production deployment.
Maintain a centralized inventory of payer rules, configuration, dependencies, and changes to ensure accuracy and traceability.
Monitor rule performance and proactively identify configuration defects, conflicting logic, processing exceptions, and opportunities for optimization.
Partner with RCM and Payer Relations/Market Access to translate payer changes, denial trends, and operational findings into rule updates and related system changes.
Identify opportunities to prevent denials, unbilled revenue, and manual rework through improved rules configuration and automation.
Provide technical direction, design review, and coaching to analysts and configuration specialists within the payer rules team, without direct people-management responsibility.
Partner closely with IT and other technical stakeholders on the InRule–Brightree integration, data dependencies, environment management, releases, and production support.
Serve as the bridge between business requirements and the rules engine, ensuring requirements are translated into scalable and maintainable rule logic.
Support new payer implementations, acquisitions, integrations, and future-state system migrations.
Qualifications
5+ years of hands-on experience in healthcare technology, payer configuration, business-rules administration, systems configuration, or a related technical function…