Director, Revenue Cycle

About us

Pomelo Care is a multi-disciplinary team of clinicians, engineers and problem solvers who are passionate about improving care for moms and babies. We are transforming outcomes for pregnant people and babies with evidence-based pregnancy and newborn care at scale. Our technology-driven care platform enables us to engage patients early, conduct individualized risk assessments for poor pregnancy outcomes, and deliver coordinated, personalized virtual care throughout pregnancy, NICU stays, and the first postpartum year. We measure ourselves by reductions in preterm births, NICU admissions, c-sections and maternal mortality; we improve outcomes and reduce healthcare spend.

Role Description

Your north star: You will be accountable for overseeing the Pomelo medical coding and billing function, ensuring that we are accurately coding and billing encounters that are reflective of all of the services we provide.

In this role, you will have the following 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 

Who you are

• 7+ years revenue cycle experience required
• 5+ years medical coding experience preferred
• Certified Professional Coder (CPC) certification or equivalent coding certification preferred
• In-depth knowledge of CPT and ICD-10 coding guidelines and Medicaid coding rules
• Meticulous attention to detail
• Passionate about maternal and child health

Bonus if you have the following

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

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 where you will have a profound impact on the patients we serve. And you'll learn, grow, 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.

At Pomelo, we are committed to hiring the best team to improve outcomes for all mothers and babies, regardless of their background. We need diverse perspectives to reflect the diversity of problems we face and the population we serve. We look to hire people from a variety of backgrounds, including but not limited to race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status.

Our salary ranges are based on paying competitively for our company’s size and industry, and are one part of the total compensation package that also includes equity, benefits, and other opportunities at Pomelo Care. In accordance with New York City, Colorado, California, and other applicable laws, Pomelo Care is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including qualifications for the role, experience level, skillset, geography, and balancing internal equity. A reasonable estimate of the current salary range is $150,000-$180,000. We expect most candidates to fall in the middle of the range. We also believe that your personal needs and preferences should be taken into consideration, so we allow some choice between equity and cash.

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