Director, Revenue Cycle

Summary

Join Pomelo Care, a dynamic healthcare startup, as a Medical Coding and Billing Lead. You will oversee the medical coding and billing function, ensuring accurate coding and billing practices. Lead and mentor a team of medical coding and billing managers and specialists. Streamline internal processes and infrastructure for encounter coding and billing. Collaborate with cross-functional teams to ensure compliance and address coding/billing questions. Track and report on key performance indicators (KPIs) and implement process improvements to enhance efficiency and maximize revenue. This role requires 7+ years of revenue cycle experience in a fast-growing healthcare setting and a strong data-driven approach.

Requirements

• 7+ years revenue cycle experience required, ideally at a fast-growing healthcare startup
• Extremely data-driven, with a strong degree of accountability toward revenue cycle metrics
• Excellent problem solver
• Meticulous attention to detail
• Passionate about maternal and child health

Responsibilities

• Lead a team of medical coding and billing managers and specialists
• Streamline all internal processes and infrastructure for encounter coding and billing as we rapidly scale
• Collaborate with coding and billing team managers to build out trainings to support improved documentation for clinicians
• Stay up to date with coding regulations, guidelines, and changes in Medicaid rules, ensuring compliance with coding requirements
• Collaborate with our partnerships and customer success teams, as well as our health plan partners, on researching state-specific coding or billing related questions prior to health plan launches
• Track and report on billing and coding team KPIs, including team productivity, clean claims rate, outstanding A/R, denial rates, etc
• Identify and implement process improvements to enhance efficiency and effectiveness in revenue cycle operations and maximize value generation for the business
• Conduct regular audits to ensure accuracy of billing practices and no revenue or reporting leakage
• Work closely with Finance team on revenue reporting and reconciliation

Preferred Qualifications

• Experience coding for telehealth companies (including asynchronous encounters)
• Experience with the athenahealth EHR
• Expertise in coding for obstetrics/gynecology and pediatrics

Benefits

• Equity
• Benefits
• Other opportunities at Pomelo Care
• Salary range is $150,000-$180,000
• Some choice between equity and cash