About the Role:

AsDirector, Value Capture Strategy & Revenue Cycle, you will lead the Coding/Billing and Credentialing teams to meet HEDIS quality reporting and medical management requirements under Imagine Pediatrics’ value-based care contracts. Primary functions and responsibilities of this role will include:

• Develop and operationalize coding and billing workflows to appropriately capture and compliantly report HEDIS measures and the appropriate ICD-10 and CPT codes for zero-dollar provider encounters to health plans
• Develop and implement initiatives for increasing HEDIS gap closure
• Collaborate with clinical operations to develop efficient and sustainable clinical workflows that optimize closing HEDIS gaps in care

• Partner with the Data and Quality teams to measure and validate HEDIS gap closure achievement

• Develop state and payor specific coding workflows to ensure coding accuracy and compliance (proper documentation that supports diagnosis, procedures, and treatment results, etc.) before claims are submitted to health plans.
• Oversee the implementation of new coding/billing processes and HEDIS measure reporting as we launch new contracts and/or new markets
• Serve as point person for relationships with health plan partners for things related to claim submissions and credentialing
• Accountability over our quality gap reporting, rev cycle management, and overall claims and provider roster reporting
• Manage the Credentialing function to ensure Imagine providers maintain current credentials and licenses to render services
• Develop reporting capabilities to track productivity & accuracy of the Coding/Billing team and develop metrics to measure team and individual performance
• Develop reporting capabilities to track productivity & timeliness of the Credentialing team and develop metrics to measure team and individual performance
• Serve as the subject matter expert in projects and initiatives related to the above

About You

First and foremost, you’re passionate and committed to creating the world our sickest children deserve. You want an active role in building a diverse and values-driven culture. Things change quickly in a start-up environment; you accept that and are willing and able to react quickly to time-sensitive needs of the business with agility and accuracy. In this role, you will need:

• Bachelor’s degree (preferably in healthcare administration or related field)
• Minimum of 8 years of management experience within a healthcare and/or managed care organization with significant experience in Medicaid products in a quality/risk adjustment or revenue cycle capacity. Experience with value-based reimbursement strategies and affordability initiatives preferred.
• Previously led development, implementation, and operations of a successful diagnosis capture model and have overseen and managed the individual funnels across the revenue management life cycle
• Experience building a robust performance monitoring structure, ideally in a high growth tech-enabled healthcare services company or insurance company
• Outcomes-focused and data driven, with an ability to bring best practices and strategies to bear quickly in overseeing the team to drive timely results
• Intuitive navigator of team and interpersonal dynamics, skilled at exerting direct and indirect influence in order to get things done
• Excellent communication skills and a strong editorial mindset towards clean and crisp messaging. You can modulate content and medium thoughtfully for audience scale and seniority.
• Strong people manager that can appropriately balance effective delivery on goals as well as strong professional development for direct reports and their teams.
• Self-aware leader and team member interested in feedback and growth.
• Ability to work effectively in a dynamic and fast-paced environment
• An effective leader that can manage, problem solve, and execute
• Ability and willingness to train and transfer knowledge down to junior level staff
• Strong organizational, documentation and problem-solving skills