Revenue Cycle Operations Analyst

November 11

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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

• The Revenue Cycle Operations Analyst plays a critical role in safeguarding the financial and operational health of Imagine Pediatrics. • Ensure the integrity, accuracy, and compliance of all billing and coding operations across Imagine’s multi-state payer landscape. • Identify claim-level breakdowns, denial trends, and systemic risks in real time. • Bring deep expertise in claims submission logic, payer policies, denial workflows, and remittance analysis—with particular emphasis on Medicaid and MCO payers. • Create automated alerts for payer-specific issues (taxonomy mismatches, POS errors, 277CA rejections, etc.). • Perform pre- and post-submission audits of claims to catch billing, modifier, place-of-service, taxonomy, or coding errors before they become denials. • Monitor payer denials and rejections to identify systemic coding, documentation, or setup issues. • Develop and maintain denial trend dashboards and root cause logs to guide corrective action planning. • Ensure claims follow internal SOPs for billing, coding, and modifier application. • Provide targeted education to coders, billers, and clinical teams based on audit findings.

🎯 Requirements

• 5–7+ years of progressive experience in revenue cycle quality assurance, data analytics, or compliance auditing within a multi-state health tech or managed care environment. • Demonstrated expertise in Athena billing workflows, payer logic, and denial analytics with hands-on experience running ad hoc reports, root cause analysis (RCA), and performance dashboards. • Experience collaborating with data, product, and compliance teams to operationalize payer rules and close system-level gaps in real time. • Advanced understanding of CPT, ICD-10, modifiers, place of service, payer logic, and Medicaid/MCO rules; commercial payer knowledge a plus. • Understanding of OIG/CMS, HEDIS, audit standards, QA integrity & regulatory readiness • Proficiency in Athena billing and denial workflows (Epic, Cerner, or eClinicalWorks experience also valued). • Strong Excel/data reporting skills; Excel, SQL, Power BI or Tableau • Ability to run ad hoc reports, interpret results, and turn insights into actionable recommendations. • Familiarity with HEDIS measures, risk adjustment, or value-based care tracking preferred. • One or more of the following certifications preferred: CPC, CRC, or RHIT (AAPC/AHIMA) for coding and compliance expertise, CPMA (Certified Professional Medical Auditor) or CHRI (Certified Healthcare Revenue Integrity) for audit and integrity focus, Certified Health Data Analyst (CHDA) or Lean Six Sigma Green Belt for analytics and process improvement

🏖️ 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