Senior Revenue Cycle Strategy and Operations Manager

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.