Senior Revenue Cycle Strategy and Operations Manager
New
P
Pomelo CareDigital Health
Open to any candidates located in the continental USFull-TimeSenior
Salary$135,000-$150,000
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Job Details
- Experience
- 5–7 years
- Required Skills
- SQLTableauMicrosoft ExcelGoogle SheetsLooker
Requirements
- 5–7 years of healthcare revenue cycle experience.
- Experience in a healthcare startup, digital health company, or multi-specialty group.
- Deep understanding of commercial and Medicaid insurance billing and claim formats.
- Expertise in denial resolution and navigating non-traditional or emerging healthcare benefits.
- Advanced proficiency in Google Sheets/Excel.
- Experience writing basic SQL.
- Experience using BI tools like Metabase, Tableau, or Looker.
- Experience leveraging AI for workflow efficiency.
- Proven track record of managing high-impact projects and software configurations.
- Ability to build cross-departmental consensus.
- Ability to thrive in ambiguity and design scalable operational systems.
Responsibilities
- Partner with Finance to design and implement competitive pricing strategies.
- Develop hybrid FFS/PEMPM billing models and lead coding discussions.
- Manage B2B client RCM onboarding and launch new service lines.
- Map and implement cross-functional billing workflows across Sales, Success, and Product.
- Serve as the escalation point for high-level operational issues.
- Partner with tech teams to manage and refine the proprietary RCM tech stack.
- Analyze financial impacts of shifting payer rules and benefit structures.
- Maintain advanced financial models to audit billing data and reconcile payments.
- Establish quality metrics, audit guidelines, and SOPs for billing operations.
- Own denial management and identify root causes for proactive prevention.
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