Senior Revenue Cycle Strategy and Operations Manager

Pomelo Care

9d • $135,000 - $150,000 • Remote

About The Position

Pomelo Care is seeking a Senior Revenue Cycle Strategy and Operations Manager to serve as a strategic partner for sustainable growth and high-quality patient care through financial stewardship, data-driven insights, and operational excellence. This role operates at the intersection of strategic RCM, financial collaboration, data analytics, and operational project management within a fast-growing startup environment. The manager will architect systems, coding frameworks, and strategies to maximize financial results, navigate complex commercial agreements, design hybrid billing structures, and handle high-level RCM escalations. This role reports to the Head of RCM and is open to candidates located in the continental US.

Requirements

• 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.
• Advanced proficiency in Google Sheets/Excel.
• 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.

Nice To Haves

• Experience leading coding discussions and navigating non-traditional or emerging healthcare benefits (like doula care or value-based capitation models) is highly preferred.
• Experience writing basic SQL or using BI tools like Metabase, Tableau, or Looker to pull data is highly preferred, alongside leveraging AI to improve efficiency and effectiveness of work products.

Responsibilities

• 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)

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed