Manager, Revenue Cycle Operations Remote

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.

• 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.
• Serves 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.
• Manages a hybrid team of billing specialists, coders, and RCM coordinators, including oversight of offshore or vendor‑supported teams.
• Defines clear role expectations, accountability frameworks, and handoffs between Coding, Billing, and RCM Operations.
• Designs structured development plans and performance dashboards to promote career progression within the RCM team.
• Partners 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.
• Serves as the primary liaison between Revenue Cycle, Compliance, and Payer Strategy leadership to ensure consistency in reporting, escalation management, and issue resolution.
• Collaborates with the QA/RCM Specialist to review audit findings, identify root causes, and implement corrective actions that strengthen process integrity
• Prepares and presents weekly/monthly RCM performance reports and root cause analyses to the Director and senior leadership team.
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