[Remote] Revenue Cycle Operations Analyst at Imagine Pediatrics

United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, PediatricsIndustries

Requirements

Deep expertise in claims submission logic, payer policies (particularly Medicaid and MCO payers), denial workflows, and remittance analysis
Ability to build or query from Athena exports, Power BI, or Tableau; analyze data without waiting for product/tech teams
Proficiency in building dashboards (Excel, Power BI, Tableau) to surface systemic risks and track financial impact

Responsibilities

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
Validate that claims align with payer-specific billing policies, CPT/ICD logic, and contract requirements
Identify and correct issues related to claim edits, rejections, clearinghouse scrubs, or EHR mapping errors
Proactively flag claims at risk for denial or underpayment and provide root cause feedback to RCM leadership
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
Serve as the first line of analysis for payer pushback on CPT codes, modifiers, or provider taxonomy
Coordinate with RCM and Compliance leadership when denial patterns suggest broader regulatory or contractual concerns
Ensure claims follow internal SOPs for billing, coding, and modifier application
Audit for consistency between coding guidance, EHR configuration, and front-end workflows
Flag SOP breakdowns and partner with RCM leadership to update documentation and workflows
Assist in creating and maintaining internal reference guides for payer-specific rules, frequently denied codes, and billing scenarios
Produce monthly and ad hoc reporting on claim acceptance, denial categories, payer acknowledgement, and reprocessing trends
Validate payer acknowledgement vs. adjudication status (“accepted” vs. “acknowledged but pending”)
Provide targeted education to coders, billers, and clinical teams based on audit findings
Collaborate with Billing and Coding leadership to deliver real-time coaching on common error patterns
Support onboarding and upskilling of new team members with payer rules, denial prevention, and documentation best practices
Work with Credentialing, Clinical, and Compliance teams to resolve issues impacting claim integrity (taxonomy mismatches, enrollment gaps, inactive NPIs)
Escalate high-risk items that may affect compliance, HEDIS reporting, or value-based incentive payments
Collaborate directly with data/informatics team to ensure payer logic updates are reflected in EHR build

Skills

Key technologies and capabilities for this role

Revenue Cycle ManagementClaims SubmissionDenial ManagementBilling AuditsCPT CodingICD CodingPayer PoliciesMedicaidMCORemittance Analysis277CA RejectionsClearinghouse ScrubsEHR MappingDashboardsRoot Cause Analysis

Questions & Answers

Common questions about this position

What is the salary range for the Revenue Cycle Operations Analyst position?

This information is not specified in the job description.

Is this Revenue Cycle Operations Analyst role remote or office-based?

This information is not specified in the job description.

What key skills are required for the Revenue Cycle Operations Analyst role?

The role requires deep expertise in claims submission logic, payer policies (especially Medicaid and MCO payers), denial workflows, remittance analysis, CPT/ICD logic, and building dashboards using Excel, Power BI, or Tableau.

What is the team structure for this Revenue Cycle Operations Analyst position?

The role is embedded within the Revenue Cycle Management (RCM) team and involves coordination with RCM leadership, Compliance leadership, and other teams.

What makes a strong candidate for the Revenue Cycle Operations Analyst role?

Strong candidates have expertise in identifying claim-level breakdowns, denial trends, payer-specific billing rules, and creating dashboards, with the ability to perform audits, analyze remittances, and produce reporting.

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