[Hiring] Manager, Revenue Cycle Operations @Imagine Pediatrics

Role Description

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.

• 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.
• KPI Management & Strategy Support:
  • 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.
• 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.
• Team Leadership & Development:
  • 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.
• Technology & System Optimization:
  • 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.

Qualifications

• 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

• Base salary range of $100,000 - $130,000 in addition to annual bonus incentive.
• Competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable).
• 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.

Company Description

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.