Remote Senior Revenue Cycle Strategy and Operations Leader

Pomelo Care; New York (NY); Remote; USD 135,000 - 150,000; Full time

Benefits offered by this job

Health insurance

Dental & Vision coverage

HSA options

FSA

Equity grant participation

401(k) program

Generous vacation policy

16 weeks paid parental leave

Fully remote work within the US

Job summary

Pomelo Care is seeking a Senior Revenue Cycle Strategy and Operations Manager to drive strategic RCM initiatives, financial stewardship, and data-driven improvements across multiple billings models including PEMPM capitation and FFS lines.

The role collaborates with Finance, Product, and Tech to optimize revenue, build scalable tools, and navigate complex payer requirements, with remote work flexibility across the US.

Qualifications

• 5-7 years of healthcare revenue cycle experience, ideally in a startup or multi-specialty setting.
• Proven ability to design pricing strategies with Finance and collaborate with Product/Tech to build scalable tools.
• Deep understanding of commercial and Medicaid insurance billing, claim formats, and denial resolution.
• Experience leading coding discussions and navigating innovative healthcare benefits is highly preferred.
• Advanced proficiency in Google Sheets/Excel; SQL and BI tools experience is highly preferred.
• Track record of managing high-impact projects and implementing new software configurations.

Responsibilities

• Partner with Finance and Sales to design pricing strategies and hybrid billing models for new B2B clients.
• Act as the dedicated escalation point for high-level RCM issues to protect leadership bandwidth.
• Collaborate with internal tech teams to build and scale proprietary RCM software with data integrity across EHRs and BI platforms.
• Monitor regulatory updates and payer rule changes to adapt systems and assess financial impact.
• Use BI tools and financial modeling to analyze KPIs, audit billing workflows, and surface denials.
• Develop QA frameworks, SOPs, and audit guidelines to elevate operational rigor.
• Oversee day-to-day revenue cycle tasks including claims submission, clearinghouse resolutions, and payments.

Skills

Excel

SQL

BI tools

Data analytics

Financial modeling

Revenue cycle knowledge

Healthcare payer billing

Cross-functional collaboration

Tools

Metabase

Tableau

Looker

Job description

Pomelo Care is seeking a Senior Revenue Cycle Strategy and Operations Manager to drive strategic RCM initiatives, financial stewardship, and data-driven improvements across multiple billings models including PEMPM capitation and FFS lines.

The role collaborates with Finance, Product, and Tech to optimize revenue, build scalable tools, and navigate complex payer requirements, with remote work flexibility across the US.