Revenue Cycle Operations Analyst

What You’ll Do

The Revenue Cycle Operations Analyst plays a critical role in safeguarding the financial and operational health of Imagine Pediatrics. Embedded within the Revenue Cycle Management (RCM) team, this role ensures the integrity, accuracy, and compliance of all billing and coding operations across Imagine’s multi-state payer landscape.

This position is responsible for identifying claim-level breakdowns, denial trends, and systemic risks in real time. The Analyst brings deep expertise in claims submission logic, payer policies, denial workflows, and remittance analysis—with particular emphasis on Medicaid and MCO payers. You will:

Claim-Level Quality Assurance

• 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.

Denial & Remittance Analysis

• 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.

SOP Execution & Operational Risk Mitigation

• 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.

Analytics & Reporting

• 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.
  • Ad Hoc Analytics Expertise: Must be able to build or query from Athena exports, Power BI, or Tableau; ability to analyze data without waiting for product/tech teams.
• Validate payer acknowledgement vs. adjudication status (“accepted” vs. “acknowledged but pending”).

Training, Education & Performance Coaching

• 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.

Cross-Functional Risk Resolution

• 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.
• Cross-Team Bridge: 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.

What You Bring & How You Qualify
First and foremost, you’re passionate and committed to reimagining pediatric health care and creating a world where every child with complex medical conditions gets the care and support they deserve. In this role, you will need:

• 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.
• 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

What We Offer (Benefits + Perks)

The role offers a base salary range of $65,000 - $80,000 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