Director, Revenue Cycle Management

What You’ll Do 

The Director of Revenue Cycle Management will report to the Senior Vice President, Partner Success. You will be responsible for ensuring operational excellence across all aspects of revenue cycle operations, including coding and billing. Imagine is pioneering a risk-based model of healthcare that provides virtual and in-home care to children with special healthcare needs. Under our value-based model, we are paid via a capitation arrangement and submit accompanying encounters/claims to our health plan partners. The claims we submit are not traditional fee-for-service claims given our unique value-based care arrangements with our plan partners, but they are a critical aspect of capturing our utilization and quality gap closure.  You will be integral to ensuring the continued success and scalability of our unique model. This role is right for you if you are excited by the opportunity to apply industry standard billing practices to our innovative care model. Responsibilities include:  

• Maintain a coding philosophy that supports an emphasis on care quality and clinical outcomes.
• Create, maintain, and execute a repeatable and scalable playbook for coding and billing that can be implemented to meet state and payer-specific requirements and ensure coding accuracy and compliance.  
• Partner with technical teams to maintain and refine configuration of coding and billing Platform [Athena] to support efficient coding and billing workflows. 
• Establish revenue cycle KPI’s and develop dashboards and reports that enable performance and compliance monitoring.  
• Ensure that all care team billing practices are compliant with relevant regulations and standards, including federal (e.g. HIPAA), and state specific Medicaid regulations. 
• Partner with compliance leadership and audit personnel to ensure billing and coding policies, procedures, and work products conform to our compliance and quality requirements.
• Partner with external consultants and vendors as needed to assess, develop, and implement state-specific Medicaid coding and billing procedures.  
• Collaborate with payers to understand coding and billing requirements and resolve issues, as needed.
• Provide leadership to a growing revenue cycle management team including coders and billers.  
• Partner cross-functionally with Compliance, Quality & Safety, Clinical Delivery, and various operational teams to ensure consistent level of education on value-based care principles, coding guidelines, and documentation requirements across the organization.  
• Partner with the Growth and Partner Success teams to evaluate relevant regulations and policies for new states that are being evaluated for market entry. 
  
  

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:

• Minimum of 8 years of experience managing revenue cycle operations in a high-growth environment in partnership with CMS and/or commercial payers; provider-side experience preferred, but not required.
• 4 years managing, mentoring, and developing team members.  
• Experience in value-based care and/or Medicaid strongly preferred.
• Experience in a provider organization that is high growth and expanding nationally across states and insurance lines (e.g., Medicaid, Commercial preferred across states and lines of business (e.g., Medicaid, Commercial).
• Demonstrated ability to craft and iteratively improve upon coding and billing processes from scratch.
• Experience owning relationships with an EHR or RCM vendors preferred.
• Certified medical coding background required.
• Prior experience with tele-health preferred, but not required. 

What We Offer (Benefits Perks) 
 
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