Manager, Revenue Cycle Operations

What You’ll Do 

The Manager, Revenue Cycle Operations will work across teams to align claims processes, ensure clean claim performance, and drive operational efficiency with a mindset rooted in accountability, problem-solving, and excellence. You will:

Operational Excellence & Claims Performance 

• 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. 

KPI Management & Strategy Support 

• 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. 

Capitation & Value-Based Care Readiness 

• 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. 

Cross-Functional Collaboration & Expansion Support 

• 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. 

Team Leadership & Development 

• 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. 

Process Improvement & Governance 

• 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. 

Technology & System Optimization 

• Collaborates with Product and IT to optimize EHR, clearinghouse, and automation tools (e.g., claim scrubber rules, payer enrollment logic, dashboard integrations). 

• Identifies opportunities for automation and process digitization to reduce manual interventions. 

Compliance & Audit Readiness

• Highlight specific Adjust projects or dashboards you’ve built; concrete examples stand out.
• Prepare a short case study of a claim‑denial reduction initiative you led, focusing on the process and tools used.
• Emphasize your Excel expertise by sharing a sample spreadsheet or describing a macro you wrote.
• Mention any experience with pediatric or telehealth billing, as it aligns directly with Imaginepediatrics’ model.
• During interviews, ask about the current claim clean‑rate and how success is measured; it shows strategic interest.
• Negotiate remote‑work allowances (internet, coworking space) if they’re not listed in the benefits.
• Watch for vague descriptions of reporting hierarchy; clarify who you’ll report to and team size early on.