Job Description

The Revenue Cycle Operations Analyst is a critical role focused on maintaining the financial and operational health of Imagine Pediatrics by ensuring the accuracy, integrity, and compliance of billing and coding operations across multiple states. This position involves identifying claim issues, analyzing denial trends, and mitigating operational risks within a tech-enabled, pediatrician-led medical group.

Responsibilities

• Create automated alerts for payer issues
• Perform pre and post claim submission audits
• Validate claims against payer policies
• Identify and correct claim errors
• Monitor payer denials and identify systemic issues
• Develop denial trend dashboards
• Ensure adherence to internal SOPs
• Audit for consistency in coding and workflows
• Produce monthly and ad hoc reports
• Provide education to coding and billing teams
• Collaborate with cross-functional teams to resolve claim issues

Requirements

• 5-7+ years of experience in revenue cycle quality assurance, data analytics, or compliance auditing
• Expertise in Athena billing workflows and denial analytics
• Experience collaborating with data, product, and compliance teams
• Advanced understanding of CPT, ICD-10, modifiers, and payer logic
• Proficiency in Excel, SQL, Power BI, or Tableau
• Familiarity with HEDIS measures or value-based care tracking
• CPC, CRC, RHIT, CPMA, or CHRI certification preferred

Benefits

• No benefits