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

Lead the PMO, Process Improvement, and SOP Development

• 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 across the company: standard work, playbooks, and launch checklists for new markets and new contracts.
• Write and maintain operational policies, and keep SOPs current, version controlled, and easy for frontline staff to follow.
• Make sure every major project has a measurable outcome and a defined finish line.

Drive the Operating System

You will make sure referrals, intake, hiring, credentialing, scheduling, care delivery, and billing work as one connected system.

• Drive performance across the full patient funnel: referrals → intakes → sessions → revenue, partnering with each area's leader to set clear conversion targets at every stage.
• Lead business operations and the PMO, and serve as the operations partner to care coordination, credentialing, and scheduling so each area hits its goals.
• Build a workflow driven, process driven operation: documented SOPs, clear handoffs, and a named owner at every step.
• Set KPIs with each function's leader and review them on a weekly and monthly cadence.
• Find bottlenecks at the system level and remove them for good.
• Build processes that scale across states without adding headcount at the same rate.

Run Operations by the Numbers

You will manage operations with every workflow tied to cost, margin, and cash.

• Manage the operating Budget for the functions you lead 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 business case, with dollar impact and payback period, before any major operational investment.
• Translate financial results into operating actions your leaders can execute this week.

Drive Capacity and Workforce Planning

You will make sure we have the right clinicians, credentialed with the right payers, in the right places, at the right time.

• Build the capacity model that connects demand, hiring, credentialing timelines, and scheduled sessions.
• Cut time from offer to first billable session.
• Drive clinician utilization and schedule fill rates toward target.
• Align hiring plans with signed contracts and referral volume.

Drive Operational Compliance and Risk Management

• Partner with compliance and clinical leaders so operations meet Medicaid requirements, state regulations, accreditation standards, and HIPAA.
• Write operational policies and procedures that turn those requirements into clear daily steps.
• Spot risks early and bring solutions and action plans, not simply flags.
• Build compliance into daily workflows so it holds up as we scale.

Make Every Direct Contract Work

You will turn signed contracts into working programs that hit their projected economics.

• Partner with the CEO and Growth to pressure test the staffing and margin assumptions behind a contract before it is signed.
• Drive the implementation plan across teams, with SOPs, workflows, and launch KPIs defined before go live for staffing, onboarding, credentialing, service delivery, billing setup, and reporting.
• Track actual performance against projected economics after launch.
• Lead post launch reviews and act when a contract misses target, whether that means fixing operations, restaffing, or bringing a repricing case to the CEO.

Drive the Operational Side of Revenue Cycle

Most claim problems start upstream. You will fix them there.

• Work with each team to drive accuracy in the front end inputs to revenue: eligibility checks, authorizations, credentialing status, documentation timeliness, and coding accuracy at the point of care.
• Partner with the CEO and the RCM team on clean claim rate, denials, days in A/R, and cash collections.
• Use claims and denial data to find the operational root cause, then change the workflow and update the SOP.

Lead People and Administration

• Provide executive oversight of HR, including talent, compensation, benefits, and workforce planning.
• Manage critical vendor relationships and contracts, with a clear view of cost and performance.
• Build a culture where leaders know their numbers, own their outcomes, and follow through.

Partner with Technology on Roadmap and Delivery

You will be the voice of operations in technology planning, making sure the systems we build match how the work actually gets done.

• Partner with Technology to build and prioritize the roadmap, turning operational needs into clear, sequenced requirements.
• Set milestones and release timelines with Technology, and track delivery against them.
• Manage ticket intake, prioritization, and turnaround times for operational requests, with clear service levels and escalation paths.
• Make sure new tools and system changes launch with updated workflows, SOPs, and staff training.
• Measure the impact of each release on cycle time, cost, and team capacity.

The Kind of Leader Who Will Thrive Here

We are looking for an operator with a strong finance mindset, not an executive who delegates the numbers.

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 speak finance. You read a P&L, a cash forecast, and a contract margin model without help. You know what a missed credentialing deadline costs in dollars, and you lead with that number.

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 improve processes for a living. You map the current state, measure it, find the root cause, and redesign the workflow. Then you document it in clear SOPs and policies so the improvement sticks. You use Lean Six Sigma tools because they work, not because they look good on a slide.

You live in the KPIs. You know the daily, weekly, and monthly metrics that drive the business, and you use them to make decisions.

You hold people accountable. You set clear expectations, inspect results, have direct conversations when targets are missed, and follow through until the issue is resolved.

You operate with urgency. In healthcare, delays have consequences. A slow hire, a delayed credential, or a missed claim affects both our financial performance and a family's ability to get care.

You are an AI native operator. Your first instinct is to ask: can we automate this, can we build it, can AI do this faster or better? Backpack is building an AI enabled data environment where leaders interrogate company data through simple prompts, and we expect this role to take full advantage of it.

You move between the weeds and the big picture. One day you are walking a scheduling workflow step by step. The next, you are presenting an operating plan to the board alongside the CEO.

You don't take direct feedback personally. This is a high accountability environment. You can separate ego from outcomes, push back thoughtfully with data, and keep moving forward.

What We're Looking For

Experience

• 10+ years of progressive operations leadership, including at least 5 years in healthcare.
• Behavioral health, Medicaid, or managed care experience strongly preferred.
• 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.
• A track record of redesigning processes end to end, with measured results in cycle time, cost, quality, or cash, and documenting them 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.

Degrees

• Bachelor's degree in Business Administration, Operations Management, Industrial or Systems Engineering, Healthcare Administration, Finance, or a related field.
• Advanced degree strongly preferred: MBA (operations or finance concentration), MHA, MPH with a management focus, or MS in Operations Management, Industrial Engineering, or Engineering Management.

Certifications

We value formal training in project management and process improvement. One or more of the following is strongly preferred:

• Lean Six Sigma: Black Belt preferred; Green Belt at minimum. Master Black Belt is a plus.
• Project and program management: Project Management Professional (PMP) or Program Management Professional (PgMP) from PMI.
• Agile delivery: PMI Agile Certified Practitioner (PMI ACP), Certified ScrumMaster (CSM), or SAFe certification.
• Lean and quality: Lean certification (such as SME Lean Bronze or Silver, or a Certified Lean Practitioner credential), or ASQ Certified Manager of Quality/Organizational Excellence (CMQ/OE).
• Healthcare quality and leadership: Certified Professional in Healthcare Quality (CPHQ) or Fellow of the American College of Healthcare Executives (FACHE).
• Healthcare finance and revenue cycle: HFMA Certified Healthcare Financial Professional (CHFP) or Certified Revenue Cycle Representative (CRCR).

Hard Skills

• SOP development and policy writing: clear, auditable SOPs, policies, and procedures for a regulated healthcare environment.
• Workflow and process design: value stream mapping, process mapping (Visio, Lucidchart, or similar), root cause analysis, control charts, and standard work.
• Financial modeling and unit economics: building capacity, staffing, and contract margin models in Excel or Google Sheets.
• Data and analytics: 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.

What We Offer

Base Salary: $225,000 to $250,000 annually

• Performance bonus tied to measurable KPI outcomes
• Exceptional equity package
• Medical, dental, and vision coverage
• 401(k)
• The opportunity to directly shape 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

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.