Manager, Revenue Cycle Operations

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October 20

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Imagine Pediatrics

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Healthcare • Wellness • B2C

Imagine Pediatrics is a healthcare provider focused on delivering specialized pediatric care. The company is dedicated to improving children's health through personalized medical attention, preventive care, and effective treatment options. With a team of experienced professionals, Imagine Pediatrics aims to create a supportive and welcoming environment for children and their families, emphasizing the importance of a healthy start for all individuals.

51 - 200 employees

🧘 Wellness

👥 B2C

📋 Description

• Lead end-to-end billing and coding operations across fee-for-service, capitation, and hybrid payment models. • Monitor daily claims workflows, denials, and claim edits to ensure clean, compliant submissions across all states and payers. • Ensure provider documentation aligns with encounter-level billing requirements, especially for virtual and episodic care models. • Serves as point of escalation for high-impact payer denials, coding discrepancies, and claim rejections requiring cross-department coordination. • Track core RCM KPIs (e.g., clean claim rate, AR days, denial rate, chart lag, encounter reconciliation) and surface insights to leadership. • Partner with analytics to develop dashboards that inform real-time decisions and revenue forecasting. • Identify high-impact trends and lead cross-functional initiatives to improve performance, quality, and speed. • Ensure appropriate coding and encounter reconciliation processes under capitation and full-risk agreements. • Support quality measure capture (e.g., HEDIS), risk adjustment coding, and care coordination billing opportunities. • Collaborate with medical, product, and operations teams to align payment integrity with clinical outcomes and contract goals. • Partner with Credentialing, Implementation, Clinical Ops, and Compliance to ensure state and payer readiness. • Lead market expansion readiness efforts, including taxonomy mapping, EFT/ERA setup, clearinghouse configuration, and payer portal access. • Co-lead provider onboarding sessions and internal training on documentation, coding, and encounter submission workflows. • Directly manage billing and coding staff; establish shift structures, review cycles, and career development plans. • Promote accountability through performance metrics, SOP adherence, and real-time coaching. • Build a team culture focused on curiosity, compliance, collaboration, and continuous improvement.

🎯 Requirements

• 8+ years of progressive revenue cycle experience, including 5+ years in leadership or strategic operations roles with direct accountability for results (clean claim rate, AR, denials, payer yield). • Proven success building or turning around RCM operations in a multi-state or multi-payer environment. • Strong command of payer policy interpretation, provider enrollment workflows, and payer portal management for both Medicaid and commercial lines of business. • Hands-on experience with capitated and value-based payment models, encounter reconciliation, and HEDIS/quality measure integration. • Advanced Athenahealth expertise (or similar enterprise EHR) with a demonstrated ability to optimize claim scrub rules, taxonomy mapping, and automation logic. • Lean Six Sigma, PMP, or process optimization background is strongly preferred. • Working knowledge of pediatric, primary care, or behavioral health coding and documentation standards preferred. • Certified Professional Coder (AAPC or AHIMA) required; additional certifications (CPPM, CPCO, or CHFP) preferred. • Proficiency in Excel, Tableau, and claims analytics tools; able to extract and translate data into operational insights.

🏖️ Benefits

• Competitive medical, dental, and vision insurance • Healthcare and Dependent Care FSA; Company-funded HSA • 401(k) with 4% match, vested 100% from day one • Employer-paid short and long-term disability • Life insurance at 1x annual salary • 20 days PTO + 10 Company Holidays & 2 Floating Holidays • Paid new parent leave • Additional benefits to be detailed in offer