Strategy & Operations Manager - Insurance

• You'll report to the Head of Operations and work closely with our RCM, fulfillment, and product teams to keep orders clean, moving, and compliant while we scale across states.
• This role offers a unique opportunity to shape insurance operations in a high-growth startup environment, working hands-on with industry leaders and driving impact across our patient population.
• Investigative & Detail-Oriented: You treat a stuck order like a case to crack. You follow the trail through eligibility responses, payer portals, and system flags until you find the real reason - not just the symptom.
• Systems-Minded, Not One-Off: You resolve the case in front of you and then build the SOP or flag that stops the next one.
• Collaborative: You partner across RCM, fulfillment, clinical, and product to unblock orders and cut turnaround time.
• Tech-Savvy & Efficiency-Focused: You use tools, portals, and metrics to work faster and catch the patterns people miss.
• Mission-Aligned: You care deeply about healthcare access and getting patients what they need without the wait.
• Investigate coverage and eligibility: Verify insurance, discover unknown or secondary coverage from patient demographics, and resolve mismatches between eligibility results and order routing.
• Do the detective work: When an order is stuck, trace it to root cause - lapsed coverage, wrong plan, MCO carve-out, entity/NPI mismatch, documentation gaps - and drive it to resolution.
• Own prior authorization: Submit, track, and follow up on prior auths and appeals; keep turnaround tight.
• Work denials and rejections: Resolve them, identify the patterns behind them, and close the gaps that cause them.
• Research payers: Maintain working knowledge of plan structures, coverage policies, and fee schedules across our active and expansion states.
• Build the systems: Develop and maintain SOPs; turn recurring investigations into repeatable, ideally automated, workflows.
• Track & report KPIs: Measure eligibility hit rate, auth turnaround, denial rate, and clean-order rate; prepare reports and surface insights to leadership.
• 3+ years in DME or healthcare insurance operations, eligibility/benefits verification, prior authorization, RCM, or medical billing.
• Strong working knowledge of Medicaid, Medicare, and commercial payer rules; DMEPOS experience a strong plus.
• Hands-on experience with eligibility and clearinghouse tools (e.g., Availity, eMedNY, payer portals) and EMR or order-ordering platforms.
• An investigative mindset - you enjoy untangling messy, ambiguous problems and getting to the bottom of them.
• Experience building SOPs and improving processes in a regulated environment.
• Stellar communication and collaboration skills.
• Excellence, Not Perfection - We set a high bar for our work and impact, but we don't get lost in endless polish for polish's sake. We focus on results that matter.
• Urgency, Not Chaos - We move fast because speed drives our advantage. We pair urgency with clarity to avoid noise and burnout.
• Systems, Not One-Offs - Every solution should eliminate the root cause so the problem never returns. Wins are good; scalable systems are better.
• Crush Goals, Not Souls - We take our work seriously, but not ourselves. Be yourself, bring positivity, have fun, and laugh often.

None flagged.