Chief Operating & Financial Officer (COFO)

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 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.

• 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.

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.

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.

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.

• 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.

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.

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.

• 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.

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.

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

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.