Revenue Cycle Operations Analyst

Revenue Cycle Operations Analyst

Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24 / 7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity.

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 analysiswith particular emphasis on Medicaid and MCO payers. You will :

• 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.

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.

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 :

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 :

We're guided by our five core values :

We Value Diversity, Equity, Inclusion and Belonging

We believe that creating a world where every child with complex medical conditions gets the care and support, they deserve requires a diverse team with diverse perspectives. We're proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law.