Salesforce RCM Lead – Healthcare Revenue Cycle Management

Job Description

We are seeking an experienced Salesforce RCM Lead to lead healthcare Revenue Cycle Management (RCM) transformation initiatives leveraging Salesforce platforms. The ideal candidate will have strong experience in healthcare payer/provider operations, claims management, billing workflows, patient/member engagement, and Salesforce Health Cloud or Service Cloud implementations.

The Salesforce RCM Lead will work closely with business stakeholders, IT teams, and healthcare operations teams to design solutions that improve revenue cycle processes, enhance patient/member experiences, streamline claims workflows, and optimize healthcare administrative operations.

Key Responsibilities

• Lead Salesforce-based RCM initiatives across healthcare payer and provider organizations.
• Analyze current revenue cycle processes and identify opportunities for automation and optimization.
• Design Salesforce solutions supporting:
• Patient/member services
• Claims management
• Billing inquiries
• Insurance verification
• Prior authorization workflows
• Denial management
• Provider services
• Partner with business stakeholders, clinical teams, billing teams, and IT teams to define requirements.
• Translate healthcare business processes into Salesforce solutions.
• Lead Salesforce Health Cloud / Service Cloud configuration and implementation activities.
• Define user stories, process flows, functional requirements, and acceptance criteria.
• Support integrations between Salesforce and healthcare systems such as:
• EHR/EMR platforms
• Claims processing systems
• Billing platforms
• CRM/contact center platforms
• Lead testing, UAT, deployment, and production support activities.
• Mentor Salesforce analysts, administrators, and developers.

Required Skills

• Strong experience with Salesforce Health Cloud and/or Salesforce Service Cloud
• Strong understanding of Healthcare Revenue Cycle Management (RCM)
• Experience with:
• Claims processing
• Medical billing
• Insurance verification
• Prior authorization
• Denial management
• Patient/member engagement
• Provider services
• Experience gathering requirements and leading Salesforce implementations.
• Strong knowledge of Salesforce configuration:
• Objects
• Workflows/Flows
• Reports & Dashboards
• Case Management
• Service Console
• Experience working with healthcare data and HIPAA-compliant environments.
• Strong communication skills with both business and technical teams.

Preferred Qualifications

• Salesforce Certified Health Cloud Consultant
• Salesforce Service Cloud Consultant
• Salesforce Certified Administrator
• Experience with healthcare payer/provider organizations
• Experience with Salesforce integrations using APIs, MuleSoft, or middleware platforms
• Experience leading offshore/onshore delivery team