Manager, Revenue Cycle Operations

🕒 vor 1 Monat

🤠 Texas – Remote

🤠 Texas – Remote

💵 $100.000 - $130.000 / Jahr

⏰ Vollzeit

🟠 Senior

🔴 Experte

⚙️ Operations

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Imagine Pediatrics

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51 - 200 Mitarbeiter

🧘 Wellness

👥 B2C

Healthcare • Wellness • B2C

Imagine Pediatrics ist ein Gesundheitsdienstleister, der sich auf die Bereitstellung spezialisierter Kinderbetreuung konzentriert. Das Unternehmen engagiert sich für die Verbesserung der Gesundheit von Kindern durch individuelle medizinische Betreuung, präventive Maßnahmen und effektive Behandlungsmöglichkeiten. Mit einem Team erfahrener Fachkräfte strebt Imagine Pediatrics an, für Kinder und ihre Familien ein unterstützendes und einladendes Umfeld zu schaffen und dabei die Bedeutung eines gesunden Starts für alle Individuen zu betonen.

Beschreibung

• Work across teams to align claims processes, ensure clean claim performance, and drive operational efficiency with a mindset rooted in accountability, problem-solving, and excellence. • 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. • Serve 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. • Collaborate with medical, product, and operations teams to align payment integrity with clinical outcomes and contract goals. • 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.

🎯 Anforderungen

• 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.

🏖️ Vorteile

• 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