Imagine Pediatrics · 2 months ago
Revenue Cycle Operations Analyst
United States
Full-time
Remote
Mid, Senior Level
$65K/yr - $80K/yr
5+ years expImagine Pediatrics is a tech-enabled, pediatrician-led medical group focused on enhancing care for children with special health care needs. The Revenue Cycle Operations Analyst will ensure the integrity and compliance of billing and coding operations while identifying claim-level issues and trends, ultimately safeguarding the financial health of the organization.
Child CareHospitalMedical
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 before they become denials
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
Build dashboards (Excel, Power BI, Tableau) that surface systemic risks and track financial impact
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
Direct collaboration with data/informatics team to ensure payer logic updates are reflected in EHR build and claim rules
Act as the liaison between QA, Denials, and Compliance to ensure risks are addressed holistically
Qualification
Required
5–7+ years of progressive experience in revenue cycle quality assurance, data analytics, or compliance auditing within a multi-state health tech or managed care environment
Demonstrated expertise in Athena billing workflows, payer logic, and denial analytics with hands-on experience running ad hoc reports, root cause analysis (RCA), and performance dashboards
Experience collaborating with data, product, and compliance teams to operationalize payer rules and close system-level gaps in real time
Advanced understanding of CPT, ICD-10, modifiers, place of service, payer logic, and Medicaid/MCO rules; commercial payer knowledge a plus
Understanding of OIG/CMS, HEDIS, audit standards, QA integrity & regulatory readiness
Proficiency in Athena billing and denial workflows (Epic, Cerner, or eClinicalWorks experience also valued)
Strong Excel/data reporting skills; Excel, SQL, Power BI or Tableau
Ability to run ad hoc reports, interpret results, and turn insights into actionable recommendations
Preferred
Familiarity with HEDIS measures, risk adjustment, or value-based care tracking preferred
One or more of the following certifications preferred: CPC, CRC, or RHIT (AAPC/AHIMA) for coding and compliance expertise
CPMA (Certified Professional Medical Auditor) or CHRI (Certified Healthcare Revenue Integrity) for audit and integrity focus
Certified Health Data Analyst (CHDA) or Lean Six Sigma Green Belt for analytics and process improvement
Benefits
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
Company
Imagine Pediatrics
Imagine Pediatrics is a virtual healthcare service for children with complex medical conditions.
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
$104.62M2025-09-17Series B· $67M
2025-03-12Series A· $37.62M
Leadership Team
Meghan Haycraft
Co-Founder and SVP Clinical Product
Taylor Beery
Co-Founder, Chief Innovation and Administrative Officer
Recent News
Behavioral Health Business
2026-01-15
Behavioral Health Business
2025-10-16
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