Revenue Cycle InRule Lead - Payer Rules & Brightree

Cardinal Health; Helena (MT); Remote; USD 89,000 - 114,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off

Health savings account (HSA)

401k savings plan

Access to wages with myFlexPay

FSAs

Disability coverage

Work-Life resources

Paid parental leave

Healthy lifestyle programs

Job summary

Cardinal Health seeks a Manager for Revenue Cycle – InRule Administration to own payer-specific rules within InRule and optimize end-to-end order‑to‑cash workflows with Brightree. You will translate payer policies into scalable rule logic and collaborate with payer rules analysts and configuration specialists.

This role partners with IT and RCM teams to drive rule improvements, ensure governance, and support new payer implementations and acquisitions across the U.S. healthcare payer landscape.

Qualifications

• 5+ years of hands‑on experience in healthcare technology, payer configuration, business‑rules administration, systems configuration, or a related technical function preferred.
• Bachelor's degree in related field, or equivalent work experience, preferred.
• Direct experience developing and administering a business‑rules engine, decision‑management platform, or comparable rules‑based technology.
• Demonstrated ability to independently author, debug, and optimize complex rules and decision logic without relying on an IT developer to perform the technical work.
• Demonstrated ability to translate complex business requirements into technical rules and decision logic within a rules engine, along with the downstream system configuration needed to support them.
• Experience with rule development/configuration, testing, debugging, deployment, version control, and production support.
• Ability to troubleshoot rule execution, configuration defects, data dependencies, and system‑processing issues.
• Experience partnering with technical teams on system integrations, data flows, APIs/interfaces, or application configuration, including the data fluency (SQL or equivalent) to trace and validate the data feeding rules.
• Strong understanding of healthcare payer policies, coverage requirements, reimbursement, and claims processes.
• Experience with InRule strongly preferred, but comparable rules‑engine or decision‑management platform experience will be considered.
• Brightree or other healthcare/DME platform experience preferred, particularly experience building rules or logic that integrate with such a platform rather than residing inside it.
• Proven ability to operate as the technical expert within a larger team, influencing through expertise and collaboration rather than reporting lines.

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.

Skills

Payer configuration

Rules engine

InRule

SQL

Brightree integration

Rule development

System integration

Education

Bachelor's degree

Tools

InRule

Brightree

Job description

Cardinal Health seeks a Manager for Revenue Cycle – InRule Administration to own payer-specific rules within InRule and optimize end-to-end order‑to‑cash workflows with Brightree. You will translate payer policies into scalable rule logic and collaborate with payer rules analysts and configuration specialists.

This role partners with IT and RCM teams to drive rule improvements, ensure governance, and support new payer implementations and acquisitions across the U.S. healthcare payer landscape.