Senior Revenue Cycle Strategy and Operations Manager

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

Benefits offered by this job

Health coverage

Dental & Vision coverage

HSA options

FSA

Equity grant participation

401(k) program

Paid parental leave (16 weeks)

Fully remote within US

Job summary

Pomelo Care is a leading virtual medical practice serving women and children nationwide. We seek a Senior Revenue Cycle Strategy and Operations Manager to drive financial stewardship, data insights, and operational excellence across multiple billing models.

You will partner with Finance and Sales to design pricing, lead RCM initiatives for new B2B clients, and optimize our RCM software across EHRs and BI platforms. This role enables growth in a fast-paced startup, with remote work within the US.

Qualifications

• 5–7 years of healthcare revenue cycle experience or healthcare startup experience.
• Proven ability to 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.

Responsibilities

• Partner with Finance and Sales to design pricing strategies and hybrid FFS/PEMPM billing models.
• Lead RCM onboarding for new B2B clients and resolve high-level escalations.
• Collaborate with internal tech teams to build and scale proprietary RCM software across EHRs and BI platforms.
• Monitor regulatory updates and payer rules to evaluate financial impact and preempt system changes.
• Use BI and financial modeling to analyze KPIs, audit billing workflows, and surface denial patterns.
• Develop QA frameworks, SOPs, and audit guidelines to elevate operational rigor.
• Oversee day-to-day revenue cycle execution including claims submission and payment posting.

Skills

Financial modeling

Excel

SQL

BI tools

Data analytics

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.