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Pomelo Care is a virtual medical practice for women and children, delivering care across pregnancy, postpartum, pediatrics, menopause, and perimenopause. The company combines 24/7 clinical care with technology to identify risks early and deliver personalized care nationwide.
As Senior Revenue Cycle Strategy and Operations Manager, you will serve as a strategic partner enabling sustainable growth and high-quality patient care through financial stewardship, data-driven insights, and operational excellence. You will sit at the intersection of strategic RCM, financial collaboration, data analytics, and operational project management in a fast-growing startup environment.
Key responsibilities include:
**Strategic Pricing, Growth & Sales Strategy (35%):** Partner with Finance to design competitive pricing strategies. Lead complex coding discussions and establish hybrid FFS/PEMPM billing models that optimize commercial agreements and maximize customer lifetime value. Lead RCM onboarding for new B2B clients and complex lines of business. Map and implement billing workflows bridging Sales, Customer Success, and Product. Act as the dedicated tier for high-level operational escalations.
**Tech Team Collaboration & Tech Stack Optimization (25%):** Partner with internal tech teams to build and refine the proprietary RCM tech stack. Ensure tech integrations enable efficient scaling, maintain quality, pass audits, and minimize transaction costs. Serve as strategic super-user across multi-system tech stack (EHRs, Clearinghouses, internal databases) to guarantee data integrity.
**Research, Analysis & Systems Adaptation (20%):** Proactively research healthcare industry shifts, plan benefit changes, and regulatory updates to adapt systems ahead of market changes. Analyze how shifting payer rules impact company financials. Utilize BI tools like Metabase to monitor revenue cycle health, track KPIs, and identify denial trends. Build and maintain advanced financial models for billing audits and payment reconciliation.
**Operational Quality & Denial Strategy (20%):** Establish quality metrics, audit guidelines, and SOPs for billing workflows. Own denial management strategy, identifying operational root causes to prevent future rejections. Monitor and optimize daily RCM execution including claim submission, clearinghouse error resolution, and payment posting.
The role reports to the Head of RCM and is open to candidates in the continental US.
