Senior Revenue Cycle Strategy and Operations Manager
New
P
Pomelo CareHealthcare revenue cycle
Open to any candidates located in the continental USFull-TimeManager
SalaryThe 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
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Job Details
- Experience
- 5–7 years of healthcare revenue cycle experience
- Required Skills
- SQLTableauMicrosoft ExcelGoogle SheetsLooker
Requirements
- Have 5–7 years of healthcare revenue cycle experience.
- Bring experience ideally from a healthcare startup, digital health company, or multi-specialty group.
- Partner with Finance to design pricing structures and collaborate with Product/Tech to build scalable operational tools.
- Understand commercial and Medicaid insurance billing, claim formats, and denial resolution.
- Bring experience leading coding discussions; experience with emerging healthcare benefits or value-based capitation models is highly preferred.
- Have advanced proficiency in Google Sheets or Excel.
- Basic SQL or experience using BI tools such as Metabase, Tableau, or Looker is highly preferred.
- Have a track record managing high-impact projects, implementing software configurations, and building cross-departmental consensus as a senior individual contributor.
Responsibilities
- Partner with Finance and Sales to design pricing strategies, build hybrid FFS/PEMPM billing models, and lead RCM onboarding for new B2B clients.
- Resolve 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 and evaluate their financial impact.
- Use BI tools and financial modeling to analyze performance metrics, audit billing workflows, reconcile payments, and identify denial patterns.
- Develop quality assurance frameworks, standard operating procedures, and audit guidelines.
- Oversee claims submission, clearinghouse error resolution, payment posting, and root-cause denial prevention.
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