Chief Operating and Financial Officer
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Job Description
COFO running financial performance, revenue cycle, and operations for a Medicaid-first behavioral healthcare company. Building scalable systems and profitability across five states.
Responsibilities:
- Own budgeting, forecasting, monthly close, financial reporting, GAAP-compliant financial operations, operating model, unit economics, and financial planning
- Translate financial data into operating decisions and establish financial discipline, visibility, and accountability
- Serve as primary financial voice to the board and investors
- Partner with the CEO on fundraising, financial modeling, investor materials, diligence, and financing negotiations
- Take executive ownership of billing, collections, revenue cycle performance, clean claims, denials, days in A/R, and cash collections across states and payers
- Analyze payer performance, reimbursement trends, and operational leakage
- Partner on Medicaid and MCO pricing, bids, and rate negotiations
- Model direct-contract economics and margins, establish implementation plans and requirements, track performance, and conduct post-launch reviews
- Lead business operations, PMO, strategy and operations, credentialing, and care coordination
- Establish KPIs, review performance, hold leaders accountable, build scalable multi-state processes, prepare market launches, and eliminate operational bottlenecks
- Provide executive oversight of HR, including talent, compensation, benefits, and workforce planning
- Manage critical vendor relationships and contracts
- Ensure compliance with Medicaid requirements, state regulations, HIPAA, and applicable accounting standards
- Identify risks and build sustainable compliance processes
- Use AI and technology to analyze information, automate work, interrogate company data, and improve decisions
Requirements:
- Bachelor's degree in Accounting, Finance, Business Administration, or a related field
- 10+ years of progressive finance and operations leadership experience, including at least 5 years in healthcare
- Hands-on experience with Medicaid reimbursement and revenue cycle management
- Demonstrated success helping a growth-stage or venture-backed company move toward profitability
- Experience presenting directly to boards and investors
- Experience supporting at least one institutional fundraising round
- Demonstrated success redesigning financial and operational processes end to end
- Proven ability to build cultures of accountability and consistently hit measurable targets
- Strong financial modeling, analytical, strategic, and operational skills
- Genuine commitment to expanding access to behavioral healthcare for underserved children and families
- MBA or CPA strongly preferred
- Behavioral health experience strongly preferred
- Multi-state healthcare operations experience preferred
Benefits:
- Performance bonus tied to measurable KPI outcomes
- Exceptional equity package
- Medical, dental, and vision coverage
- 401(k)
- Opportunity to directly influence the growth and trajectory of a venture-backed healthcare company
- The chance to help expand access to behavioral healthcare for children and families who need it most
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