Manager, Revenue Cycle Operations
I
Imagine PediatricsHealthcare
Remote, USAFull-TimeManager
Salary100,000 - 130,000 USD per year
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Job Details
- Experience
- 8+ years of progressive revenue cycle experience, including 5+ years in leadership or strategic operations roles
- Required Skills
- TableauMicrosoft ExcelEHR
Requirements
- 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.
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.
- Track core RCM KPIs (e.g., clean claim rate, AR days, denial rate, chart lag, encounter reconciliation) and surface insights to leadership.
- Ensure appropriate coding and encounter reconciliation processes under capitation and full-risk agreements.
- Partner with Credentialing, Implementation, Clinical Ops, and Compliance to ensure state and payer readiness.
- Directly manage billing and coding staff; establish shift structures, review cycles, and career development plans.
- Own RCM SOPs and escalation paths; identify bottlenecks and build workflows that scale.
- Collaborates with Product and IT to optimize EHR, clearinghouse, and automation tools (e.g., claim scrubber rules, payer enrollment logic, dashboard integrations).
- Ensures organizational compliance with CMS, OIG, and payer audit standards.
- Prepares and presents weekly/monthly RCM performance reports and root cause analyses to the Director and senior leadership team.
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