Chief Operating & Financial Officer (COFO)

Chief Operating & Financial Officer (COFO) Backpack Healthcare | Hybrid/Remote | Preferred: MD, GA, IL, MI, or VA Build the Operating and Financial Engine Behind the Future of Behavioral Healthcare Backpack Healthcare is on a mission to make high-quality mental healthcare more accessible to children, adolescents, young adults, and families who have historically been left out of the system. We are 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, we are growing quickly while building a clear path to profitability. We are looking for a Chief Operating & Financial Officer (COFO) who is ready to help build what comes next. This is not a role for someone who wants to sit on the sidelines, analyze what happened, and prepare reports. You will run the operating and financial engine of Backpack Healthcare. You will own the numbers, own the outcomes, and lead the teams responsible for delivering both. You will work directly with our CEO and leadership team to turn data into decisions, decisions into execution, and execution into measurable results. If you are energized by complexity, move quickly, love solving hard problems, and want to have a direct impact on the trajectory of a growing healthcare company, this could be the opportunity for you. What You'll Do 💰 Own Financial Performance & Profitability You will be accountable for Backpack's financial performance and the plan that gets us to sustainable profitability. - Own budgeting, forecasting, monthly close, financial reporting, and GAAP-compliant financial operations. - Build and manage the company's operating model, unit economics, and financial planning processes. - Translate financial data into clear operating decisions and actionable priorities. - Establish the financial discipline, visibility, and accountability required to scale. - Serve as a primary financial voice to our board and investors. - Present company performance, forecasts, risks, opportunities, and the path to profitability with confidence. - Partner with the CEO on fundraising, including financial modeling, investor materials, diligence, and financing negotiations. 💵 Own Revenue Cycle & Payer Economics Revenue cycle isn't something you'll review from a distance. You'll own the results. - Take executive ownership of billing, collections, and revenue cycle performance across all states and payers. - Drive measurable improvements in clean claims, denials, days in A/R, and cash collections. - Analyze payer performance, reimbursement trends, and operational leakage. - Partner with Growth and Partnerships on Medicaid and MCO pricing, bids, and rate negotiations. - Identify opportunities to improve reimbursement, margin, and cash flow. 🤝 Make Every Direct Contract Work Every contract needs to make business sense. - Model the economics and expected margin of direct contracts before they are signed. - Build the operational and financial plan required for successful implementation. - Establish staffing, onboarding, billing, and KPI requirements before launch. - Track actual performance against projected economics after launch. - Conduct post-launch reviews and take action when contracts miss targets — whether that means fixing operations, repricing, or renegotiating. ⚙️ Lead Business Operations You will connect the dots across the organization and ensure our systems actually work together. Your scope will include business operations, PMO, strategy and operations, credentialing, and care coordination. - Establish clear KPIs for each function and review performance on a consistent cadence. - Hold leaders accountable for measurable outcomes. - Build scalable processes that support multi-state growth. - Help prepare the organization for new market launches and expansion. - Identify operational bottlenecks and eliminate them at the system level. - Ensure that referrals, hiring, credentialing, scheduling, billing, contracts, and cash work together as one operating system. 👥 Lead People & Administration - Provide executive oversight of the HR function, including talent, compensation, benefits, and workforce planning. - Partner with leadership to ensure we have the right people, structure, and accountability to support growth. - Manage critical vendor relationships and contracts. - Build an environment where leaders understand their numbers, own their outcomes, and follow through. 🛡️ Own Compliance & Risk - Ensure operational and financial compliance with Medicaid requirements, state regulations, HIPAA, and applicable accounting standards. - Identify risks before they become problems. - Bring solutions and action plans — not simply flags. - Build processes that make compliance sustainable as Backpack scales. The Kind of Leader Who Will Thrive Here We are looking for an operator, not simply an executive with an impressive résumé. You act. You see a problem on Monday and have a plan moving by Tuesday. You don't wait for perfect information or endless consensus. You hold people accountable. You establish clear expectations, inspect results, have direct conversations when targets are missed, and follow through until the issue is resolved. You live in the KPIs. You know the daily, weekly, and monthly metrics that drive the business. You use them to make decisions — not decorate PowerPoint slides. You operate with urgency. In healthcare, delays have consequences. A slow hire, delayed credentialing, missed claim, or inefficient workflow can affect both the company's financial performance and a family's ability to access care. You're relentlessly curious. You don't make assumptions. You ask why until you understand the root cause. You are willing to get into the claims data, understand payer mix, examine workflows, and pressure-test the economics of a contract yourself before making a recommendation. You think in systems. This is a requirement. You understand how referrals connect to intake, how hiring connects to capacity, how credentialing connects to revenue, how scheduling connects to utilization, and how billing connects to cash. You don't patch symptoms. You fix systems. You are an AI-native operator. You see technology and AI as force multipliers. Your first instinct is to ask: Can we automate this? Can we build it? Can AI do this faster or better? You use AI yourself to move faster, analyze information, and make better decisions. Backpack is building an AI-enabled data environment where leaders can access and interrogate company data through simple prompts — and we expect this role to take full advantage of it. You can move between the weeds and the big picture. One day you may be digging into a claims report or contract margin. The next, you're presenting a profitability strategy to the board. You are equally comfortable doing the analysis yourself and stepping back to determine the strategic move. You can keep up. You'll work alongside a CEO who understands clinical operations, recruiting, forecasting, revenue cycle, growth, and the data connecting them. You will be expected to bring answers, challenge assumptions, move quickly, and continuously raise the bar. You are comfortable in the investor room. You can confidently represent the business to our board and investors. You know the numbers. You understand the story behind them. You can defend the plan, answer difficult questions, communicate risks honestly, and build confidence in where the company is going. You don't take direct feedback personally. This is a high-accountability environment. You will receive direct feedback and be expected to give it in return. You can separate ego from outcomes, absorb tough feedback without becoming defensive, push back thoughtfully with data, and keep moving forward. What We're Looking For - Bachelor's degree in Accounting, Finance, Business Administration, or a related field. - MBA or CPA strongly preferred. - 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; behavioral health experience strongly preferred. - 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. - Multi-state healthcare operations experience preferred. - 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. What We Offer Base Salary: $225,000–$300,000 annually Plus: - 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 Why Backpack? At Backpack Healthcare, we believe everyone carries an invisible backpack filled with experiences, stress, trauma, and challenges that others may not see. Our job is to help make that backpack a little lighter. As our COFO, you'll have the opportunity to build the systems, financial foundation, and operational infrastructure that allow us to reach more families — while helping build a company that is financially strong enough to serve them for the long term. If you're looking for a traditional CFO seat, this probably isn't it. If you're looking for a role where you can build, operate, challenge, solve, and make a measurable impact every day, we'd love to meet you. Join Backpack Healthcare and help keep the financial foundation strong behind the work we do every day. 🎒 Backpack Health is an Equal Opportunity Employer. We believe that the strength of our care depends on the diversity and wellbeing of our team. We celebrate differences in age, color, disability, ethnicity, gender identity or expression, national origin, physical and mental ability, race, religion, sexual orientation, veteran status, and other traits that make each person unique. We welcome and encourage diverse candidates to apply for any position for which they are qualified and to bring their unique perspectives, experiences, and talents to our team.