Senior Revenue Cycle Strategy and Operations Manager

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

Benefits offered by this job

Fully remote work flexibility (within‑

Equity grant participation

401(k) program

Health, Dental, Vision coverage

HSA options

FSA

16 weeks paid parental leave

Job summary

Pomelo Care is seeking a Senior Revenue Cycle Strategy and Operations Manager to lead strategic RCM initiatives across multiple lines of business. You will design pricing, build scalable billing models, and address high-level escalations while partnering with Finance, Sales, Product, and Tech.

You will optimize processes, drive data-driven decisions, monitor policy updates, and implement robust governance to maximize patient care revenue and organizational efficiency.

Qualifications

• 5-7 years in healthcare revenue cycle.
• Experience designing pricing structures and collaborating with product/tech.
• Proficient in Excel/Google Sheets; basic SQL.
• Experience with BI tools (Metabase/Tableau/Looker) and data-driven decisions.

Responsibilities

• Partner with Finance and Sales to design pricing strategies and build hybrid FFS/PEMPM billing models.
• Serve as the dedicated resolution point for high-level RCM escalations.
• Collaborate with internal tech teams to build, scale, and maintain RCM software; ensure data integrity across systems.
• Monitor regulatory updates and payer rule changes to assess financial impact and adapt systems.
• Use BI and financial modeling to analyze KPIs, audit workflows, reconcile payments, and identify denials.
• Develop QA frameworks, SOPs, and audit guidelines to raise operational rigor.
• Oversee day-to-day revenue cycle execution including claims submission and payment posting.

Skills

Revenue cycle

Start-up experience

SQL basics

Excel/Google Sheets

BI tooling

Data analysis

Cross-team collaboration

Pricing strategy

Project management

Strategic thinking

AI tooling

Tools

Metabase

Tableau

Looker

Job description

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.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:

• 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.

Who You Are:

• 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) is highly preferred.

• 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.

• 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.

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.

We are committed to hiring the best team to improve outcomes for all mothers and babies. To solve the complex challenges facing the diverse population we serve, we need diverse perspectives, actively welcoming people of all races, ages, sexual orientations, gender identities and expressions, national origins, religions, disabilities, and veteran statuses. We strive to cultivate an inclusive and respectful environment where team members thrive by working across disciplines, moving fast, making data driven decisions, learning continuously, and always putting the patient first.