Senior Revenue Cycle Strategy and Operations Manager

1 month, 3 weeks ago
Full-time
Senior
Operations
Pomelo Care

Pomelo Care

Pomelo Care is a virtual maternity care program that supplements traditional pregnancy care with unlimited, customized support. They offer services like consulting with a dietitian for prenatal vitamins, speaking to a therapist for labor anxiety, and j...

Health Care Providers & Services
11-50
$41M raised

Description

  • Partner with Finance to design, evaluate, and implement pricing strategies.
  • Lead coding discussions and develop hybrid FFS/PEMPM billing models.
  • Oversee RCM onboarding for new B2B clients and complex lines of business.
  • Design billing workflows connecting Sales, Customer Success, Product, and RCM.
  • Own high-level operational escalations and improve issue-resolution processes.
  • Partner with Tech to build and optimize the RCM technology stack and integrations.
  • Monitor revenue cycle KPIs, denial trends, billing data, payments, and implementation milestones.
  • Research payer, regulatory, and benefit changes and assess their financial impact.
  • Establish quality metrics, audit guidelines, and SOPs for billing workflows.
  • Oversee claims submission, clearinghouse error resolution, payment posting, and denial prevention.

Requirements

  • 5–7 years of healthcare revenue cycle experience, preferably in a startup, digital health company, or multi-specialty group.
  • Experience designing pricing structures with Finance and scalable operational tools with Product or Tech teams.
  • Deep knowledge of commercial and Medicaid billing, claim formats, and denial resolution.
  • Experience leading coding discussions and navigating emerging benefits or value-based capitation models preferred.
  • Advanced proficiency with Google Sheets or Excel.
  • Basic SQL and experience with Metabase, Tableau, or Looker preferred.
  • Experience managing high-impact projects, software configurations, and cross-functional consensus building.
  • Ability to work strategically and independently in ambiguous, fast-changing environments.
  • Experience using AI to improve work-product efficiency and effectiveness preferred.
  • Must be located in the continental United States.

Benefits

  • $135,000–$150,000 base salary, plus discretionary annual bonus and equity.
  • Comprehensive health, dental, and vision coverage for employees and families.
  • HSA and FSA options.
  • Equity grant participation and 401(k) program.
  • Competitive vacation policy.
  • 16 weeks of paid parental leave.
  • Fully remote work flexibility within the United States.

Interested in this position?

Apply directly on the company website

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