RCM Operations Manager - Pediatrics

Imagine Pediatrics; Nashville (TN); On-site; USD 100,000 - 130,000; Full time

Benefits offered by this job

Medical insurance

401(k) with match

PTO 20 days + holidays

Job summary

Imagine Pediatrics is seeking a Senior Manager of Revenue Cycle Operations to unify billing and coding across fee‑for‑service, capitation, and hybrid models. You will lead a hybrid team of billing professionals and work with cross‑functional partners to improve clean claim rates, denial management, and payment accuracy.

The role emphasizes governance, process improvement, and performance reporting to senior leadership, with a focus on Medicaid and commercial payer strategies and high‑quality

Qualifications

• 8+ years revenue cycle experience with 5+ years in leadership roles.
• Experience turning around RCM operations in multi‑state environments.
• Strong command of payer policy interpretation and enrollment workflows.
• Hands‑on with capitated and value‑based payment models.
• Advanced Athenahealth or similar EHR optimization experience.
• Lean Six Sigma or PMP certification preferred.
• Working knowledge of pediatric coding and documentation standards.
• Certified Professional Coder (AAPC or AHIMA) required; CPPM/CPCO/CHFP preferred.
• Proficiency in Excel, Tableau, and claims analytics tools.

Responsibilities

• Lead end‑to‑end billing and coding operations across different payment models.
• Monitor claims workflows, denials, and edits to ensure clean submissions.
• Ensure documentation aligns with encounter‑level billing requirements.
• Partner with analytics to develop dashboards and revenue forecasting.
• Collaborate with cross‑functional teams to align payment integrity with clinical outcomes.

Skills

RCM leadership

Payer policy interpretation

Capitated & VBC

Excel

Tableau

Lead cross‑functional teams

Process optimization

QA/compliance

Data-driven decisions

Tools

Athenahealth

EHR optimization

Job description

Imagine Pediatrics is seeking a Senior Manager of Revenue Cycle Operations to unify billing and coding across fee‑for‑service, capitation, and hybrid models. You will lead a hybrid team of billing professionals and work with cross‑functional partners to improve clean claim rates, denial management, and payment accuracy.

The role emphasizes governance, process improvement, and performance reporting to senior leadership, with a focus on Medicaid and commercial payer strategies and high‑quality