Senior Revenue Cycle Strategy and Operations Manager

About us Pomelo Care is the leading virtual medical practice for women and children, providing care across pregnancy, postpartum, pediatrics, menopause, and perimenopause. We combine proactive, 24/7 clinical care with technology that helps us reach patients earlier, identify risks sooner, and deliver personalized care throughout their journey. Our team includes clinicians, technologists, operators, and problem-solvers working together to make high-quality care more accessible for families nationwide. About The Role: 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. What you'll do: Strategic Pricing, Growth & Sales Strategy (35%) Financial & Pricing Strategy: Partner closely with the Finance team to design, evaluate, and implement competitive pricing strategies. Hybrid Billing Architecture: Lead complex coding discussions and establish viable hybrid FFS/PEMPM models or codes that optimize commercial agreements to maximize customer lifetime value. Client Onboarding & Implementation: Lead the RCM onboarding process for new B2B clients and newly launched, complex lines of business. Growth Integration: Map out, document, and implement billing workflows that bridge cross-functional gaps between Sales, Customer Success, and Product. Escalation Ownership: Act as the dedicated tier for high-level operational escalations, streamlining processes so critical issues are resolved efficiently without burdening executive leadership. Tech Team Collaboration & Tech Stack Optimization (25%) Tech Stack Partnership: Partner closely with the internal tech team to continuously build, refine, and manage our proprietary RCM tech stack. Scalability & Cost Control: Ensure our tech integrations allow us to scale operations efficiently, maintain top-tier quality, easily pass audits, and minimize overall transaction costs. Super-User Stewardship: Serve as the strategic super-user across our multi-system tech stack (EHRs, Clearinghouses, internal databases) to guarantee seamless data integrity across all platforms. Research, Analysis & Systems Adaptation (20%) Industry & Policy Research: Proactively research broader healthcare industry shifts, plan benefit changes, and regulatory updates to adapt our systems ahead of market changes. Financial Impact Evaluation: Analyze how shifting payer rules and benefit structures will impact company financials and communicate findings to leadership. Data Analytics & KPI Tracking: Utilize data tools like Metabase (or similar BI tools) to monitor overall revenue cycle health, track performance metrics, and pinpoint systemic denial trends. Financial Modeling: Build, maintain, and manipulate advanced models to audit billing data, reconcile payments, and track client implementation milestones. Operational Quality & Denial Strategy (20%) Quality Assurance & Frameworks: Establish quality metrics, audit guidelines, and standard operating procedures (SOPs) to ensure operational rigor across all billing workflows. Denial Management Strategy: Take ultimate ownership of denial management, identifying operational root causes to proactively prevent future rejections. Core RCM Process Oversight: Monitor and optimize daily core RCM execution, including claim submission, clearinghouse error resolution, and payment posting, ensuring workflows run flawlessly. Who you are: Experience: 5–7 years of healthcare revenue cycle experience, ideally within a healthcare startup, digital health company, or a multi-specialty group. Strategic Capability: Proven ability to partner with Finance to design pricing structures and collaborate with Product/Tech to build scalable operational tools. RCM & Coding Expertise: 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. Technical Chops: 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, alongside leveraging AI to improve efficiency and effectiveness of work products. Project Agility & Ownership: Proven track record of managing high-impact projects, implementing new software configurations, and building cross-departmental consensus as a senior individual contributor. Mindset: 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. Why you should join our team By joining Pomelo, you will get in on the ground floor of a fast-moving, well-funded, and mission-driven startup that always puts the patient first. You will learn, grow and be challenged, and have fun with your team while doing it. We strive to create an environment where employees from all backgrounds are respected. We value working across disciplines, moving fast, data-driven decision making, learning, and always putting the patient first. Benefits and Perks: 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. At Pomelo, we are committed to hiring the best team to improve outcomes for all mothers and babies, regardless of their background. We need diverse perspectives to reflect the diversity of problems we face and the population we serve. We look to hire people from a variety of backgrounds, including but not limited to race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status. Potential Fraud Warning Please be cautious of potential recruitment fraud. With the increase of remote work and digital hiring, phishing and job scams are on the rise with malicious actors impersonating real employees and sending fake job offers in an effort to collect personal or financial information. Pomelo Care will never ask you to pay a fee or download software as part of the interview process with our company. Pomelo Care will also never ask for your personal banking or other financial information until after you have signed an offer of employment and completed onboarding paperwork that is provided by our People Operations team. All official communication with Pomelo Care People Operations team will come from domain email addresses ending in @pomelocare.com. If you receive a message that seems suspicious, we encourage you to pause communication and contact us directly at [email protected] to confirm its legitimacy. For your safety, we also recommend applying only through our official Careers page. If you believe you have been the victim of a scam or identity theft, please contact your local law enforcement agency or another trusted authority for guidance.