Chief Operating & Financial Officer (COFO)

Backpack Healthcare is seeking a Chief Operating & Financial Officer (COFO) to run the operating and financial engine of the company. The role works directly with the CEO and leadership team to turn data into decisions, decisions into execution, and execution into measurable results. The company is a Medicaid-first, venture-backed behavioral health company delivering whole-family telehealth care across Maryland, Virginia, Georgia, Michigan, and Illinois, with 170+ clinicians, 219 employees, and more than 100 payer relationships.

Responsibilities

Run the portfolio of company initiatives with clear owners, milestones, budgets, and status; Apply Lean Six Sigma methods to map processes, cut waste, and reduce variation; Lead SOP development and operational policies across the company; Drive performance across the full patient funnel from referrals to intakes to sessions to revenue; Lead business operations and the PMO; Set KPIs with each function's leader and review them weekly and monthly; Manage the operating budget for the functions led and deliver against it; Track cost per session, clinician utilization, and contribution margin by state, payer, and contract; Partner with the CEO on the annual budget, monthly reforecasts, and the path to profitability; Build the capacity model connecting demand, hiring, credentialing timelines, and scheduled sessions; Partner with compliance and clinical leaders on Medicaid, state regulation, accreditation, and HIPAA requirements; Pressure test staffing and margin assumptions before contracts are signed; Drive implementation and post-launch reviews of direct contracts; Drive operational accuracy in revenue cycle inputs such as eligibility, authorizations, credentialing status, and coding; Provide executive oversight of HR, including talent, compensation, benefits, and workforce planning; Manage critical vendor relationships and contracts; Partner with Technology on roadmap, milestones, and operational request prioritization

Requirements

10+ years of progressive operations leadership, including at least 5 years in healthcare; Experience managing an operating Budget or P&L with a record of improving margin; Hands-on experience running credentialing, scheduling, care coordination, or the operational inputs to revenue cycle; Multistate healthcare operations experience, including launching new markets or programs; Demonstrated success helping a growth stage or venture backed company move toward profitability; Track record of redesigning processes end to end with measured results in cycle time, cost, quality, or cash, documented in SOPs and policies; Experience presenting to boards and investors alongside a CEO; Genuine commitment to expanding access to behavioral healthcare for underserved children and families; Bachelor's degree in Business Administration, Operations Management, Industrial or Systems Engineering, Healthcare Administration, Finance, or a related field; Strong finance mindset: reads a P&L, cash forecast, and contract margin model without help; Systems thinking across referrals, intake, hiring, credentialing, scheduling, care delivery, and billing; Experience with SOP development and policy writing for a regulated healthcare environment; Workflow and process design skills (value stream mapping, process mapping, root cause analysis, control charts, standard work); Financial modeling and unit economics in Excel or Google Sheets

Nice to have

Behavioral health, Medicaid, or managed care experience; Advanced degree (MBA with operations or finance concentration, MHA, MPH with management focus, or MS in Operations Management, Industrial Engineering, or Engineering Management); Lean Six Sigma Black Belt preferred (Green Belt minimum; Master Black Belt is a plus); Project or program management certification (PMP or PgMP); Agile delivery certification (PMI ACP, CSM, or SAFe); Lean and quality certification (SME Lean, Certified Lean Practitioner, or ASQ CMQ/OE); Healthcare quality or finance certification (CPHQ, FACHE, CHFP, or CRCR); SQL and a BI tool such as Tableau, Power BI, or Looker; Project and portfolio tools such as Asana, Jira, Smartsheet, or Monday.com; Working knowledge of EHR, practice management, and billing systems in a multistate Medicaid environment

Benefits

Performance bonus tied to measurable KPI outcomes; Exceptional equity package; Medical, dental, and vision coverage; 401(k); Opportunity to directly shape the growth and trajectory of a venture backed healthcare company; Chance to help expand access to behavioral healthcare for children and families