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.

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.

You are not just managing claims; you are architecting the systems, coding frameworks, and strategies that make scaling possible and maximize financial results achieved. 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.

Strategic Pricing, Growth & Sales Strategy (35%)

• Financial & Pricing Strategy: Partner closely with the Finance team to design, evaluate, and implement competitive pricing strategies.

• Hybrid Billing Architecture: Lead complex coding discussions and establish viable hybrid FFS/PEMPM models or codes that optimize commercial agreements to maximize customer lifetime value.

• Client Onboarding & Implementation: Lead the RCM onboarding process for new B2B clients and newly launched, complex lines of business.

• Growth Integration: Map out, document, and implement billing workflows that bridge cross-functional gaps between Sales, Customer Success, and Product.

• Escalation Ownership: Act as the dedicated tier for high-level operational escalations, streamlining processes so critical issues are resolved efficiently without burdening executive leadership.

Tech Team Collaboration & Tech Stack Optimization (25%)

• Tech Stack Partnership: Partner closely with the internal tech team to continuously build, refine, and manage our proprietary RCM tech stack.

• Scalability & Cost Control: Ensure our tech integrations allow us to scale operations efficiently, maintain top-tier quality, easily pass audits, and minimize overall transaction costs.

• Super-User Stewardship: Serve as the strategic super-user across our multi-system tech stack (EHRs, Clearinghouses, internal databases) to guarantee seamless data integrity across all platforms.

Research, Analysis & Systems Adaptation (20%)

• Industry & Policy Research: Proactively research broader healthcare industry shifts, plan benefit changes, and regulatory updates to adapt our systems ahead of market