Director, Revenue Cycle Management

Summary

Join Imagine Pediatrics, a multi-disciplinary pediatric group pioneering virtual-first care, as the Director of Revenue Cycle Management. Reporting to the SVP, Partner Success, you will ensure operational excellence in all aspects of revenue cycle operations, including coding and billing for our unique value-based care model. You will maintain and improve coding and billing processes, partner with technical and compliance teams, and lead a growing revenue cycle management team. This role requires extensive experience in revenue cycle management, a certified medical coding background, and a passion for improving pediatric healthcare. Imagine Pediatrics offers competitive benefits, including medical, dental, vision, 401k, paid time off, and paid parental leave.

Requirements

• Minimum of 8+ years of experience managing revenue cycle operations in a high-growth environment in partnership with CMS and/or commercial payers; provider-side experience preferred, but not required
• 4+ years managing, mentoring, and developing team members
• Demonstrated ability to craft and iteratively improve upon coding and billing processes from scratch
• Certified medical coding background required

Responsibilities

• Maintain a coding philosophy that supports an emphasis on care quality and clinical outcomes
• Create, maintain, and execute a repeatable and scalable playbook for coding and billing that can be implemented to meet state and payer-specific requirements and ensure coding accuracy and compliance
• Partner with technical teams to maintain and refine configuration of coding and billing Platform [Athena] to support efficient coding and billing workflows
• Establish revenue cycle KPI’s and develop dashboards and reports that enable performance and compliance monitoring
• Ensure that all care team billing practices are compliant with relevant regulations and standards, including federal (e.g. HIPAA), and state specific Medicaid regulations
• Partner with compliance leadership and audit personnel to ensure billing and coding policies, procedures, and work products conform to our compliance and quality requirements
• Partner with external consultants and vendors as needed to assess, develop, and implement state-specific Medicaid coding and billing procedures
• Collaborate with payers to understand coding and billing requirements and resolve issues, as needed
• Provide leadership to a growing revenue cycle management team including coders and billers
• Partner cross-functionally with Compliance, Quality & Safety, Clinical Delivery, and various operational teams to ensure consistent level of education on value-based care principles, coding guidelines, and documentation requirements across the organization
• Partner with the Growth and Partner Success teams to evaluate relevant regulations and policies for new states that are being evaluated for market entry

Preferred Qualifications

• Experience in value-based care and/or Medicaid strongly preferred
• Experience in a provider organization that is high growth and expanding nationally across states and insurance lines (e.g., Medicaid, Commercial preferred across states and lines of business (e.g., Medicaid, Commercial)
• Experience owning relationships with an EHR or RCM vendors preferred
• Prior experience with tele-health preferred, but not required

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