[Remote] Manager, Revenue Cycle Operations at Imagine Pediatrics

United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, PediatricsIndustries

Requirements

Experience leading end-to-end billing and coding operations across fee-for-service, capitation, and hybrid payment models
Ability to monitor daily claims workflows, denials, and claim edits for clean, compliant submissions across states and payers
Knowledge of provider documentation alignment with encounter-level billing, especially for virtual and episodic care
Expertise in serving as escalation point for high-impact payer denials, coding discrepancies, and claim rejections
Proficiency in tracking RCM KPIs (e.g., clean claim rate, AR days, denial rate, chart lag, encounter reconciliation)
Skills in partnering with analytics for dashboards, revenue forecasting, and identifying high-impact trends
Understanding of capitation, value-based care, quality measure capture (e.g., HEDIS), risk adjustment coding, and care coordination billing
Ability to collaborate with medical, product, operations, Credentialing, Implementation, Clinical Ops, and Compliance teams
Experience leading market expansion readiness (taxonomy mapping, EFT/ERA setup, clearinghouse configuration, payer portal access)
Capability to co-lead provider onboarding and internal training on documentation, coding, and encounter submission
Direct management experience with billing, coding staff, hybrid teams, offshore/vendor teams, including shift structures, reviews, and development plans
Skills in promoting accountability via metrics, SOPs, coaching, and building team culture (curiosity, compliance, collaboration, improvement)
Ability to define role expectations, accountability frameworks, handoffs, development plans, and performance dashboards
Partnership experience with QA/RCM for coaching based on audits and trends
Ownership of RCM SOPs, escalation paths, bottleneck identification, scalable workflows, best practices adoption, clean-up projects, and audit-readiness
Experience as liaison between Revenue Cycle, Compliance, and Payer Strategy leadership

Responsibilities

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
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
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
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

Skills

Revenue Cycle Management

Billing

Coding

Claims Processing

Denials Management

AR Days

Clean Claim Rate

Capitation

Value-Based Care

HEDIS

KPI Tracking

Dashboards

Payer Contracts

Encounter Reconciliation

Provider Documentation

Imagine Pediatrics

24/7 virtual pediatric care and support

About Imagine Pediatrics

Imagine Pediatrics offers 24/7 virtual pediatric care customized for children with medical complexity, providing unlimited access to care via messaging, phone call, or video visit, and coordinating with the child's existing care team. Their multidisciplinary team of pediatricians, nurses, social workers, and care coordinators delivers high-quality, virtual-first care and support, with services currently available in Texas and Florida.

220 Athens Way #240, Nashville, TN 37228, USAHeadquarters

2022Year Founded

$5MTotal Funding

SEEDCompany Stage

51-200Employees