RCM & Workflow Optimization Specialist – (Manager)

About the Role

This role owns end-to-end practice operations on AthenaOne (EHR, Practice Management, Revenue Cycle Management), drives workflow and Work Queue (WQ) performance, and leads rule governance (global, local, and custom rules across the four options used in your environment). The specialist will optimize the clinical-to-cash lifecycle, strengthen setup integrity, reduce leakage (missing slips/encounter defects), and enable measurable operational wins across coding, billing, collections, payment posting, and denials.

Role Responsibilities (End-to-End RCM & Athena Operations)

Encounter Integrity & Leakage Control: Drive reconciliation; Report missing slips closure; ensure coding readiness.

Coding & Billing: Enable clean claims through rule-based validations; reduce preventable denials.

Collector & Practice WQ Operations: Build, tune, and manage WQs; define routing, SLAs, and prioritization.

Payment Posting & Exceptions: Reduce exception rates; standardize workflows; manage zero-pay module.

Setup Governance: Conduct provider setup reviews, maintain CDM (Charge Description Master) accuracy, run user access & role audits.

Rule Strategy: Author and maintain Athena global rules, local rules, and custom rules across all four options used in Athena environment; test, deploy, and measure impact.

Documentation & Training: Publish SOPs/process maps; deliver role-based trainings; sustain change management.

Required Expertise & Skills

Practice work model understanding (clinical-to-cash end-to-end).

Structural knowledge across Athena modules:

oClinical, Encounter lifecycle & reconciliation, Missing slips resolution

oCoding, Billing, Collector, Practice WQ operations

oPayment Posting Exception handling and Zero Pay module

Setup functionalities: Provider setup review, CDM expertise, User access management & role understanding.

Rules expertise in Athena: Global, Local, and Custom rule creation (across all four optionsrequirements, logic, testing, deployment, monitoring).

WQ mastery: Creation, prioritization logic, routing workflow design, SLA design, exception routing.

Process workflow creation: Current/future-state mapping, governance, change control.

Strong analytical skills; ability to translate business needs into system logic and measurable outcomes.

Clear communication, stakeholder management, and training facilitation.

Qualifications - Mandatory

37+ years hands-on experience with AthenaOne (EHR, PM, RCM) and RCM workflows.

Demonstrated success in rule configuration and WQ optimization.

• Knowledge of coding standards (ICD, CPT, HCPCS), payer rules, denial management, and HIPAA-aligned practices.