Manager, Revenue Cycle Operations

Imagine Pediatrics is a tech‑enabled, pediatrician‑led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in‑home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity. What You’ll Do The Manager, Revenue Cycle Operations will 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. You will: Operational Excellence & Claims Performance 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 (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. Capitation & Value‑Based Care Readiness 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. Cross‑Functional Collaboration & Expansion Support 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. Manage a hybrid team of billing specialists, coders, and RCM coordinators, including oversight of offshore or vendor‑supported teams. Define clear role expectations, accountability frameworks, and handoffs between Coding, Billing, and RCM Operations. Design structured development plans and performance dashboards to promote career progression within the RCM team. Partner with QA/RCM to align coaching and feedback based on audit results and performance trends. Process Improvement & Governance Own RCM SOPs and escalation paths; identify bottlenecks and build workflows that scale. Drive adoption of RCM best practices across documentation, coding logic, claim edits, and payer‑specific processes. Lead clean‑up projects and ensure audit‑readiness across billing and coding operations. Serve as the primary liaison between Revenue Cycle, Compliance, and Payer Strategy leadership to ensure consistency in reporting, escalation management, and issue resolution. Collaborate with the QA/RCM Specialist to review audit findings, identify root causes, and implement corrective actions that strengthen process integrity. Prepare and present weekly/monthly RCM performance reports and root cause analyses to the Director and senior leadership team. Collaborate with Product and IT to optimize EHR, clearinghouse, and automation tools (e.g., claim scrubber rules, payer enrollment logic, dashboard integrations). Identify opportunities for automation and process digitization to reduce manual interventions. Compliance & Audit Readiness Ensure organizational compliance with CMS, OIG, and payer audit standards. Maintain audit‑ready documentation, including SOPs, coding protocols, and payer correspondence. Partner with QA/RCM specialist to interpret audit data, trend findings, and implement sustainable improvements. Ensure audit feedback loops are integrated into team workflows, dashboards, and SOP updates. Collaborate on quarterly performance and compliance reviews to drive transparency and accountability. What You Bring & How You Qualify 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. What We Offer (Benefits + Perks) 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 1× annual salary. 20 days PTO + 10 Company Holidays & 2 Floating Holidays. Paid new parent leave. Additional benefits to be detailed in offer. We value diversity, equity, inclusion, and belonging. We believe that creating a world where every child with complex medical conditions gets the care and support they deserve requires a diverse team with diverse perspectives. We’re proud to be an equal‑opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law. #J-18808-Ljbffr