Revenue Cycle Systems Architect

Title: Revenue Cycle Systems Architect

Reports to: VP, Credentialing and Billing

Classification: Manager

Location: Boston (Hybrid)

Job description revision number and date: V2.0; 05.11.26

Organization Summary: 

Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices in Massachusetts and across the country. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.

Job Summary: 

The Revenue Cycle Systems Architect is responsible for the design and optimization of the revenue cycle systems that support our FQHC customers. This role ensures that Epic and integrated revenue systems operate as a cohesive, compliant, and scalable system enabling accurate charge capture, clean claim generation, effective remittance processing, and dependable financial reporting. This position is best suited for an Epic revenue cycle expert with knowledge of Epic workflows in Resolute Professional Billing, Charge router, charge capture, SBO and Ambulatory. This role requires expertise in implementing, optimizing, and supporting end-to-end billing, registration and clinical workflows within FQHCs or complex multi-site organizations. Collaboration with Revenue Integrity, Billing/AR, Clinical Operations, Finance, IT, and customer-facing operational teams is essential.

Responsibilities: 

• Create and maintain sustainable processes in Epic, including charge build, error resolution, and revenue enhancement

• Conduct audits of charge routing workflows and implement corrective actions to eliminate recurring issues

• Act as the primary Epic Professional Billing (PB) and charge router subject-matter expert for revenue cycle initiatives

• Build and refine Epic workqueues, charge router rules, claims edits, handler tasks and PB configuration

• Partner with IT and Epic support (CTC) to troubleshoot issues, develop enhancements, and support system upgrades

• Lead testing strategies (Integrated charging and Scenario testing) to validate system build and ensure accuracy

• Identifies process and technology improvements to improve the effectiveness and efficiency of revenue cycle operations

• Provide consulting services to individual FQHCs to identify areas of focus to improve revenue cycle operations

• Develop dashboards and reporting tools to track key revenue integrity metrics, such as denials and charge accuracy

• Provide detailed analysis and insights to leadership, recommending improvements to optimize revenue cycle performance

• Monitor denial patterns and lead cross-functional corrective action plans in collaboration with Billing/AR

• Support payer transitions, FQHC expansions, and new revenue cycle initiatives

• Develop training programs focused on documentation standards, Epic workflows, coding accuracy, and payer compliance

• Collaborate with Billing/AR, Finance, Clinical, Compliance, and IT teams to ensure consistent and compliant revenue cycle practices

• Collaborates with internal and external constituents to execute improvements

• Serve as a trusted advisor across departments, leveraging in-depth system knowledge to enhance operational efficiency

• Analyzes data to identify opportunities for revenue growth and process enhancements

• Works closely with vendors and other third parties to facilitate timely and accurate data capture and collections

• Represents the billing department in audits, meetings, and organizational planning sessions

• Consistently provides service excellence to all patients, family members, visitors, volunteers, and co-workers in a manner that reflects C3’s mission and core values

• Contribute to shaping the vision for C3 as the preferred resource for an affordable and efficient MSO in Billing and Credentialing

• Perform other duties as assigned

Required Skills: 

• Epic expertise in Resolute PB, Charge Router, Ambulatory, Claims & Remittance, work queue design, data extracts and reporting

• Demonstrated leadership and ability to guide complex system builds, optimizations, and implementations

• Excellent communication skills, analytical thinking, and cross-functional collaboration abilities

• Ability to manage multiple projects simultaneously in a fast-paced, evolving environment

• Expertise with Microsoft Office Suite

• Results driven and outcome focused

• Must be innovative, comfortable with ambiguity, well-organized, and committed to moving quickly and collaboratively in the context of a rapidly changing organization

• Experience with quality improvement/change management and project management

• Proficiency in Microsoft Office Suite

• Must have a strong commitment to quality assurance and exceptional customer service

• A strong commitment to the organization’s mission

Desired Other Skills: 

• Epic revenue cycle certifications (Charge Router, PB/Resolute, EpicCare Ambulatory or related Epic modules)

• Familiarity with the MassHealth ACO program

• Experience working in Federally Qualified Health Centers (FQHCs)

• Experience with anti-racism activities, and/or lived experience with racism is highly preferred

Qualifications: 

• Bachelor’s degree in healthcare administration, business, finance, or a related field preferred

• Minimum of 5 years of Epic implementation and build experience

** In compliance with Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **