收入周期运营经理
Manager, Revenue Cycle Operations
我们是谁
Imagine Pediatrics 是一家由儿科医生领导的医疗集团,通过技术手段重新定义为有特殊健康需求的儿童提供护理的方式。我们提供 24/7 的虚拟优先和居家医疗服务、行为服务和社会服务,与家庭、医护人员和医保计划合作,打破优质护理的障碍。我们不取代现有的护理团队;我们对其进行增强,以同理心、创造力和对复杂医疗儿童的坚定承诺提供额外的支持。
你将负责的工作
收入周期运营经理将跨团队工作,协调索赔流程,确保干净的索赔表现,并以问责制、解决问题和卓越的心态推动运营效率。你将:
运营卓越与索赔表现
· 在按服务收费、包干制和混合支付模式下,领导端到端的计费和编码操作。
· 监控每日的索赔流程、拒付和索赔修改,确保所有州和付款方的干净、合规提交。
· 确保医生的文档符合就诊级别的计费要求,特别是针对虚拟和发作性护理模式。
· 作为高影响付款方拒付、编码差异和索赔拒绝的升级点,需要跨部门协作处理。
KPI 管理与策略支持
· 跟踪核心 RCM KPI(例如,干净索赔率、应收账款天数、拒付率、图表延迟、就诊核对),并向管理层提供洞察。
· 与分析团队合作,开发仪表板以支持实时决策和收入预测。
· 识别高影响趋势并领导跨职能项目以提高绩效、质量和速度。
包干制与基于价值的护理准备
· 确保在包干制和全风险协议下适当的编码和就诊核对流程。
· 支持质量指标采集(例如,HEDIS)、风险调整编码和护理协调计费机会。
· 与医疗、产品和运营团队合作,确保支付完整性与临床结果和合同目标一致。
跨职能协作与扩展支持
· 与认证、实施、临床运营和合规团队合作,确保各州和付款方的准备就绪。
· 领导市场扩展准备工作的努力,包括分类法映射、电子资金转账/电子接收确认设置、清算中心配置和付款方门户访问。
· 共同领导医生入职会议和内部培训,内容涉及文档、编码和
查看英文原文
Who We Are
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.
What You'll Do
The Manager, Revenue Cycle Operations leads the day-to-day performance of Imagine Pediatrics’ billing and coding operations, overseeing Billing and Coding Supervisors and the broader coding and billing team to ensure consistent quality, productivity, timeliness, and compliance.
This is a hands-on people and operations role for an experienced Revenue Cycle leader with strong coding and billing expertise — someone who can coach frontline leaders, resolve complex operational issues, and partner across Revenue Integrity, Analytics, Compliance, Credentialing, Clinical Operations, and Payer/Partner teams as the company scales.
In this role, you will:
Revenue Cycle Operations & Leadership
- Lead day-to-day billing and coding operations across multiple markets, payers, service lines, and payment models, with direct management oversight of Billing and Coding Supervisors
- Monitor coding queues, billing worklists, claim submission, denials, rejections, and operational backlogs; maintain staffing and capacity planning to meet service levels
- Serve as a credible technical resource — applying strong knowledge of CPT, ICD-10-CM, HCPCS, payer edits, and coding compliance — to evaluate complex operational issues
- Serve as the escalation point for complex billing, coding, workflow, staffing, and payer-related issues that exceed supervisor-level resolution, and coordinate cross-functional resolution of issues blocking claims
- Partner with Revenue Integrity and Compliance on advanced auditing, policy interpretation, or integrity investigations
- Ensure operational controls and follow-through as new workflows, payer requirements, or audit findings are introduced
- Perform other duties as assigned
Team Leadership & Development
- Lead, coach, and develop Billing and Coding Supervisors and their teams, establishing clear expectations for performance, accountability, and growth
- Build supervisory leadership capability through coaching in people management, prioritization, delegation, and problem-solving
- Establish a consistent management cadence (huddles, one-on-ones, performance reviews) and translate department goals into clear KPIs and execution plans
- Identify performance gaps early and implement coaching, development plans, or corrective actions; develop high performers and succession readiness
- Support workforce planning, hiring, onboarding, and training as operations scale
- Foster a culture of shared accountability, collaboration, and continuous improvement
Performance Management & Process Improvement
- Own and monitor operational Revenue Cycle KPIs — coding productivity and quality, turnaround time, backlog, denials, and worklist performance
- Use data and Analytics partnership to identify risks, capacity constraints, and improvement opportunities; establish action plans with clear owners and timelines
- Monitor whether corrective actions produce sustained improvement, and report performance, risks, and action plans to Revenue Cycle leadership
- Maintain and improve Revenue Cycle workflows, SOPs, and controls; lead practical improvements that increase efficiency and scalability
- Diagnose whether operational issues stem from people, process, technology, payer requirements, or cross-functional dependencies, and coordinate the right response
- Support readiness for new markets, payers, and programs, and escalate systemic issues requiring broader organizational or technical intervention
Cross-Functional Partnership
· This role partners closely with Revenue Integrity, Analytics, Compliance, Credentialing, Clinical Operations, Payer/Partner teams, and Product/Technology to resolve issues, implement changes, and drive results — while maintaining clear ownership of Revenue Cycle execution.
What You Bring & How You'll Qualify
- 7+ years of progressive Revenue Cycle experience· Substantial coding and billing operations experience required
- 3+ years of direct people leadership experience, including managing supervisors or other frontline leaders
- Certified Professional Coder (AAPC or AHIMA) required· CPPM, CPCO, or CHFP preferred
- Demonstrated ability to manage coding operations — productivity, quality, turnaround time, backlog, and denials
- Strong working knowledge of CPT, ICD-10-CM, HCPCS, documentation requirements, payer edits, and coding compliance principles
- Ability to evaluate operational issues, interpret QA findings, and determine when escalation to Revenue Integrity or Compliance is needed
- Demonstrated ability to coach, hold accountability, and develop frontline leaders and high performers
- Proven ability to lead through others and build team capability across multiple payers, markets, and service lines
- Strong communication and relationship-management skills across clinical, operational, technical, and compliance teams
- Experience with Athenahealth or a comparable EHR/practice management platform strongly preferred
- Experience in pediatric, value-based, or high-growth environments is a plus
What We Offer (Benefits + Perks)
The role offers a 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). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary.
We provide these additional benefits and perks:
- 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
What We Live By
We’re guided by our five core values:
Our Values:
- Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future.
- Earn Trust. We listen first, speak second. We build lasting relationships by creating shared understanding and consistently following through on our commitments.
- Innovate Today. We believe that small improvements lead to big impact. We stay curious by asking questions and leveraging new ideas to learn and scale.
- Embrace Humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to grow and understand how we can improve.
- One Team, Diverse Perspectives. We actively seek a range of viewpoints to achieve better outcomes. Even when we see things differently, we stay aligned on our shared mission and support one another to move forward — together.
We Value Diversity, Equity, Inclusion and Belonging
We believe that creating a world where every child with complex medical conditions gets the care and support, they deserve requires a diverse team with diverse perspectives. We're proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law.
Originally posted on Himalayas