Remote Senior Revenue Cycle Strategy & Operations Lead

Pomelo Care; United States; Remote; USD 135,000 - 150,000; Full time

Benefits offered by this job

Health, dental, vision coverage

HSA options

FSA

Equity grant

401(k)

Paid parental leave

Fully remote within US

Job summary

Pomelo Care is seeking a Senior Revenue Cycle Strategy and Operations Manager to drive strategic RCM initiatives, data-driven insights, and operational excellence across multiple lines of business. You will partner with Finance, Sales, Product, and Tech to design pricing, build scalable tools, and manage complex revenue cycles in a fast-growing startup environment.

You will lead cross-functional efforts, optimize billing workflows, and oversee escalations while leveraging BI platforms to surface

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).
• Advanced proficiency in Google Sheets/Excel. Experience writing basic SQL or using BI tools like Metabase, Tableau, or Looker to pull data, alongside leveraging AI to improve efficiency and effectiveness of work products.
• 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.

Responsibilities

• Partner with Finance and Sales to design competitive pricing strategies, build hybrid FFS/PEMPM billing models, and lead RCM onboarding for new B2B clients.
• Serve as the dedicated resolution point for high-level RCM escalations to streamline operations and protect leadership bandwidth.
• Collaborate with internal tech teams to build, optimize, and scale proprietary RCM software, maintaining data integrity across EHRs, clearinghouses, and BI platforms.
• Monitor regulatory updates, healthcare policy shifts, and payer rule changes to evaluate their financial impact and adapt systems preemptively.
• Use BI tools and advanced financial modeling to analyze key performance metrics, audit billing workflows, reconcile payments, and surface denial patterns.
• Develop quality assurance frameworks, standard operating procedures, and audit guidelines to elevate operational rigor.
• Oversee day-to-day revenue cycle execution—including claims submission, clearinghouse error resolution, payment posting, and root-cause denial prevention.

Skills

Revenue Cycle Mgmt

Financial modeling

BI tools

SQL basics

Excel/Sheets

Cross-functional leadership

Strategic partnerships

Tools

SQL

Metabase

Tableau

Looker

Job description

Pomelo Care is seeking a Senior Revenue Cycle Strategy and Operations Manager to drive strategic RCM initiatives, data-driven insights, and operational excellence across multiple lines of business. You will partner with Finance, Sales, Product, and Tech to design pricing, build scalable tools, and manage complex revenue cycles in a fast-growing startup environment.

You will lead cross-functional efforts, optimize billing workflows, and oversee escalations while leveraging BI platforms to surface