Revenue Cycle Strategy & Operations Lead — Remote & Equity

Pomelo Care; Northern (KY); Hybrid; USD 135,000 - 150,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

HSA options

FSA

Equity grant

401(k)

Paid parental leave 16 weeks

Fully remote within the US

Job summary

Pomelo Care is seeking a Senior Revenue Cycle Strategy and Operations Manager to drive financial stewardship, data-driven insights, and operational excellence across multiple revenue models.

You will partner with Finance and Sales to design pricing, build hybrid FFS/PEMPM billing, lead complex RCM initiatives, oversee software implementations, and ensure data integrity across EHRs and BI platforms, with remote work available within the US.

Qualifications

• 5-7 years of healthcare revenue cycle experience
• Partner with Finance to design pricing structures and collaborate with Product/Tech to build scalable tools
• Deep understanding of commercial and Medicaid billing, claim formats, and denial resolution
• Experience leading coding discussions and navigating emerging healthcare benefits (e.g., capitation) is preferred
• Advanced proficiency in Google Sheets/Excel; experience with BI tools to pull data; leverage AI to improve efficiency

Responsibilities

• Partner with Finance and Sales to design pricing strategies and hybrid billing models
• Serve as the escalation point for high-level RCM issues
• Collaborate with internal tech teams to build and scale RCM software with data integrity across systems
• Monitor regulatory updates and payer rule changes to assess financial impact
• Use BI and financial modeling to analyze KPIs, audit workflows, and surface denial patterns
• Develop quality assurance frameworks, SOPs, and audit guidelines
• Oversee day-to-day revenue cycle execution including claims submission, payments, and denial prevention

Skills

Revenue cycle

Data analysis

Excel

SQL

BI tools

Pricing strategy

Cross-functional collab

Tools

Metabase

Tableau

Looker

Job description

Pomelo Care is seeking a Senior Revenue Cycle Strategy and Operations Manager to drive financial stewardship, data-driven insights, and operational excellence across multiple revenue models.

You will partner with Finance and Sales to design pricing, build hybrid FFS/PEMPM billing, lead complex RCM initiatives, oversee software implementations, and ensure data integrity across EHRs and BI platforms, with remote work available within the US.