Senior Revenue Cycle Strategy and Operations Manager

Responsibilities

• Partner with Finance to design, evaluate, and implement competitive pricing strategies.
• Lead coding discussions and develop hybrid fee-for-service and per-member-per-month billing models that optimize commercial agreements and customer lifetime value.
• Lead revenue cycle management (RCM) onboarding for new B2B clients and complex lines of business.
• Map, document, and implement billing workflows across Sales, Customer Success, and Product.
• Own high-level operational escalations and streamline resolution processes.
• Partner with the technology team to build, refine, and manage the proprietary RCM technology stack.
• Ensure integrations support scalable operations, audit readiness, data quality, and transaction-cost control.
• Serve as the strategic super-user across EHRs, clearinghouses, and internal databases.
• Research healthcare industry shifts, plan benefit changes, and regulatory updates; adapt systems proactively.
• Analyze the financial impact of payer rules and benefit structures and communicate findings to leadership.
• Monitor revenue-cycle health and performance metrics using Metabase or similar BI tools; identify systemic denial trends.
• Build and maintain financial models to audit billing data, reconcile payments, and track implementation milestones.
• Establish quality metrics, audit guidelines, and standard operating procedures for billing workflows.
• Own denial-management strategy, identify root causes, and prevent future claim rejections.
• Monitor and optimize claim submission, clearinghouse error resolution, payment posting, and other core RCM processes.

Requirements

• 5–7 years of healthcare revenue cycle experience, ideally in a healthcare startup, digital health company, or multi-specialty group.
• Experience partnering with Finance on pricing structures and with Product or Technology on scalable operational tools.
• Deep knowledge of commercial and Medicaid insurance billing, claim formats, and denial resolution.
• Advanced proficiency in Google Sheets and Microsoft Excel.
• Experience managing high-impact projects, implementing software configurations, and building cross-departmental consensus as a senior individual contributor.
• Ability to operate strategically in ambiguous environments and design scalable operational processes.

Nice to Have

• Experience with coding discussions and emerging healthcare benefits, such as doula care or value-based capitation models.
• Basic SQL skills.
• Experience with Metabase, Tableau, or Looker.
• Experience leveraging AI to improve work-product efficiency and effectiveness.

Compensation and Benefits

• Base salary: $135,000–$150,000 annually.
• Eligible for an annual discretionary bonus and equity participation.
• Medical, dental, and vision coverage for employees and families.
• High-deductible health plans with HSA options.
• Flexible Spending Account.
• 401(k) program.
• Competitive vacation policy.
• 16 weeks of paid parental leave.
• Fully remote work flexibility within the United States.