JOB SUMMARY:
The Revenue Cycle Management (RCM) department is embarking on a major transformation to leverage advanced AI, specifically Anthropic's Claude, to streamline operations, reduce administrative burden, and empower teams across the revenue cycle. We are seeking an RCM AI Solutions Engineer who will design, build, and implement Claude AI-driven tools, agents, and workflows that enhance efficiency, accuracy, and decision making across the RCM lifecycle.
This role blends technical expertise, creativity, and a deep understanding of healthcare operations. You will be the department's in house expert on Claude, responsible for turning real-world RCM challenges into scalable AI solutions.
JOB RESPONSIBILITIES
ESSENTIAL FUNCTIONS:
- Lead the adoption and integration of Claude across the RCM department.
- Identify high value use cases where AI can automate tasks, reduce errors, or augment staff workflows.
- Build, test, and deploy Claude agents tailored to RCM functions such as:
- Prior authorization support, Denial management workflows, Claims status follow-up, Eligibility and benefits verification
- Create custom tools, prompts, and workflows that integrate Claude with existing systems (EHR, billing platforms, etc.).
- Ensure solutions are scalable, maintainable, and compliant
- Analyze current RCM processes to identify automation opportunities.
- Design AI-powered workflows that reduce manual effort and improve turnaround times.
- Collaborate with RCM leadership to measure impact and refine solutions.
- Partner with IT, compliance, clinical documentation, coding, billing, and finance teams to ensure safe and effective AI deployment.
- Train RCM staff on using Claude-powered tools and best practices.
- Serve as the subject matter expert for all Claude-related initiatives.
- Ensure all AI solutions adhere to HIPAA, organizational policies, and responsible AI principles.
- Implement guardrails, monitoring, and quality assurance processes for AI outputs.
- Maintain documentation for models, workflows, and decision logic.
- Perform all job responsibilities in alignment with the industry's best security practices and regulatory guidelines to protect the confidentiality, integrity, and availability of protected health information and other sensitive company data.
- Must be familiar with and abide by the Corporate Compliance Program and all Corporate policies, including the Privacy and Security policies.
NON-ESSENTIAL FUNCTIONS:
- Work with other departments within PathGroup and subsidiaries.
- Nothing in the job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
- Other duties as assigned.
EDUCATION & LICENSURE:
- Bachelor's Degree or equivalent experience is required.
QUALIFICATIONS:
- Over 3 years of experience in healthcare IT, RCM technology, or EHR/billing system integration.
- Knowledge of data privacy, security, and compliance frameworks in healthcare.
- Experience with process improvement methodologies (Lean, Six Sigma, etc.).
Skills Required
- Bachelor's degree or equivalent experience
- Over 3 years of experience in healthcare IT, RCM technology, or EHR/billing system integration
- Knowledge of data privacy, security, and compliance frameworks in healthcare (e.g., HIPAA)
- Experience with process improvement methodologies (Lean, Six Sigma, etc.)
- Experience designing, building, or deploying AI/LLM solutions, preferably Anthropic Claude
What We Do
PathGroup is an industry-leading provider of comprehensive anatomic, clinical, and molecular pathology services in the United States. It serves as the pathology provider for over 250 hospitals and thousands of physician groups and surgery centers. Physician-led and physician-centered, PathGroup is designed to work seamlessly with medical practices, providing direct consultation and high-quality laboratory testing and results.
