[Hiring] Senior Revenue Cycle Strategy and Operations Manager @Pomelo Care

Role Description

Your north star: To serve as a trusted strategic partner that enables sustainable growth and high-quality patient care through rigorous financial stewardship, data-driven insights, and operational excellence.

As the Senior Revenue Cycle Strategy and Operations Manager, you will sit at the intersection of strategic RCM, financial collaboration, data analytics, and operational project management. In our fast-growing startup environment, we operate across multiple complex lines of business—ranging from a per engaged member per month (PEMPM) capitation model to highly specialized Fee-For-Service (FFS) lines with new novel models being piloted.

You are not just managing claims; you are architecting the systems, coding frameworks, and strategies that make scaling possible and maximize financial results achieved. In this role, you will step up to navigate complex commercial agreements to secure high-value partnerships and improve deal velocity, design novel FFS/PEMPM hybrid billing structures to unlock additional revenue opportunities, and serve as the dedicated resource for high-level RCM escalations that currently flow directly to leadership.

This role reports to the Head of RCM and is open to any candidates located in the continental US.

Qualifications

• 5–7 years of healthcare revenue cycle experience, ideally within a healthcare startup, digital health company, or a multi-specialty group.
• Proven ability to partner with Finance to design pricing structures and collaborate with Product/Tech to build scalable operational tools.
• Deep understanding of commercial and Medicaid insurance billing, claim formats, and denial resolution.
• Experience leading coding discussions and navigating non-traditional or emerging healthcare benefits (like doula care or value-based capitation models) is highly preferred.
• Advanced proficiency in Google Sheets/Excel.
• Experience writing basic SQL or using BI tools like Metabase, Tableau, or Looker to pull data is highly preferred.
• Proven track record of managing high-impact projects, implementing new software configurations, and building cross-departmental consensus as a senior individual contributor.
• A builder and a strategist. You thrive in ambiguity, take pride in resolving complex organizational headwinds, and enjoy designing "how things should work" rather than just following an old playbook.

Requirements

• Partner closely with the Finance team to design, evaluate, and implement competitive pricing strategies.
• Lead complex coding discussions and establish viable hybrid FFS/PEMPM models or codes that optimize commercial agreements to maximize customer lifetime value.
• Lead the RCM onboarding process for new B2B clients and newly launched, complex lines of business.
• Map out, document, and implement billing workflows that bridge cross-functional gaps between Sales, Customer Success, and Product.
• Act as the dedicated tier for high-level operational escalations, streamlining processes so critical issues are resolved efficiently without burdening executive leadership.
• Partner closely with the internal tech team to continuously build, refine, and manage our proprietary RCM tech stack.
• Ensure our tech integrations allow us to scale operations efficiently, maintain top-tier quality, easily pass audits, and minimize overall transaction costs.
• Serve as the strategic super-user across our multi-system tech stack (EHRs, Clearinghouses, internal databases) to guarantee seamless data integrity across all platforms.
• Proactively research broader healthcare industry shifts, plan benefit changes, and regulatory updates to adapt our systems ahead of market changes.
• Analyze how shifting payer rules and benefit structures will impact company financials and communicate findings to leadership.
• Utilize data tools like Metabase (or similar BI tools) to monitor overall revenue cycle health, track performance metrics, and pinpoint systemic denial trends.
• Build, maintain, and manipulate advanced models to audit billing data, reconcile payments, and track client implementation milestones.
• Establish quality metrics, audit guidelines, and standard operating procedures (SOPs) to ensure operational rigor across all billing workflows.
• Take ultimate ownership of denial management, identifying operational root causes to proactively prevent future rejections.
• Monitor and optimize daily core RCM execution, including claim submission, clearinghouse error resolution, and payment posting, ensuring workflows run flawlessly.

Benefits

• Comprehensive Health, Dental, and Vision coverage for employees and their families.
• High deductible Health Plans with Health Savings Account (HSA) options.
• Flexible Spending Account (FSA).
• Equity grant participation.
• 401(k) program.
• Competitive vacation policy.
• 16 weeks paid parental leave.
• Fully remote work flexibility (within the US).

Compensation

The expected base salary range offered for this role is $135,000-$150,000. This role is also eligible for an annual discretionary bonus and equity, giving you an ownership stake in Pomelo’s mission. Actual compensation may vary based on relevant experience, skills, competencies, and certifications.