Senior Manager, Revenue Accounting
NexHealth · San Francisco · $151,500–$203,000 (stated in the posting)
About NexHealth
Our healthcare system remains frustratingly analog. When you live in a world of one-tap car rides, instant meal delivery, and unlimited streaming, why do you still have to call to schedule a doctor’s appointment and fill out a clipboard in the waiting room?
NexHealth’s mission is to accelerate innovation in healthcare by connecting patients, providers, and developers. We’re building the infrastructure layer for modern healthcare, connecting thousands of fragmented, on-premise, and closed EHR systems into a single, modern platform that powers software, APIs, payments, and patient experiences across the ecosystem.
- Founded: 2017
- Headquarters: San Francisco, CA
- Funding: $177M Series C
- Employees: 200+
- Trusted by tens of thousands of providers and hundreds of health-tech developers — forging the infrastructure layer that modern healthcare needs
About the Role
NexHealth is in a high-growth stage, with a revenue mix diversifying into payments, API/usage-based, and marketplace models on top of our core SaaS subscription business. We're transitioning SaaS pricing from fixed-fee toward consumption-based models, pushing more customers toward longer-term and multi-year agreements, and migrating our billing infrastructure from Chargebee to Stripe following the recent launch of our new CPQ-to-Stripe quote flow.
This role is the senior technical authority on revenue accounting at NexHealth: owning ASC 606 policy and judgment calls independently, assessing and advising on our evolving pricing structure to help the company grow while ensuring our reporting reflects it accurately, and serving as the primary point of contact for auditors on all revenue matters — all while building the Order-to-Cash function to support our next stage of growth.
What You'll Do
- Own the Order-to-Cash function end to end (billing, collections, sales tax, MRR/ARR reporting and accounting, etc.) and co-lead the design and build-out of our go-forward billing engine on Stripe, from architecture through the Chargebee migration.
- Own ASC 606 revenue recognition policy end to end as we shift toward consumption-based pricing and multi-year agreements.
- Partner with RevOps, Engineering, and Product to ensure the CPQ-to-billing pipeline holds up as transaction volume and deal complexity grow, and that underlying data flowing from Salesforce to Stripe and Snowflakes supports all critical downstream reporting (ie. MRR/ARR/CARR reporting).
- Co-own our ARR/Bookings/MRR Definitions Memo, Revenue Recognition Matrix (mapping common contract terms to their revenue treatment for Sales/RevOps self-service), Discount Authority Matrix, and related pricing governance documents with RevOps and Sales leadership.
- Reviewing contracts with Sales/RevOps for rev rec impact before signature, and briefing the Controller and CFO on key judgment calls. Co-lead our CPQ flow with the deal desk function as we build it out, serving as the revenue accounting voice on non-standard terms and deal structuring.
- Lead the Order-to-Cash team — coaching our billing/collections and reporting staff through new pricing and process rollouts, revenue reportings, owning the accuracy of revenue journal entries each close.
- Serve as NexHealth's primary point of contact with auditors on all revenue matters.
What Success Looks Like
- All of our revenue streams have documented SOP, defensible ASC 606 treatment, and MRR/ARR/CAR reporting accurately reflects them — trusted by the whole company and our investors.
- The Chargebee-to-Stripe billing migration has a clear design, solution, and project plan in place — built for automation and scalability to support our growth — ready for execution with a clean audit trail and no gaps in revenue data through cutover.
- The billing operations team is confidently running day-to-day billing, collections, and reporting under the processes and policies you've built, with clear ownership of revenue journal entries.
- You're the trusted owner of revenue — not just for clean, efficient audit cycles with our auditors, but as a go-to partner across the whole company.
- Sales and Operations see you as a trusted partner in structuring deals — flagging rev rec impact before signature, not after — and rely on you to keep billing operations running smoothly and scaling in support of their goals.
What You'll Bring
- 8+ years of accounting experience, with 5+ years in revenue accounting/rev rec in a SaaS, API, Payments, or marketplace business; CPA required or strongly preferred.
- Strong familiarity with the capabilities of systems like Stripe, Chargebee, and Salesforce — comfortable acting as a co-admin alongside the Controller and RevOps, identifying systems integration issues and process gaps, not just using these tools as an end user.
- Hands-on ASC 606 experience with usage-based allocation for consumption pricing, minimum-guarantee accounting for threshold-based API and Payments arrangements, and principal-vs-agent determination on payment take-rate revenue.
- Experience with SSP allocation for bundled SKUs and contract modification and financing component analysis on multi-year agreements.
- Comfortable working with SQL, big data, and data warehouse concepts (Snowflake or similar) — able to navigate messy, evolving table structures without getting lost, exercise sound data quality judgment, and produce reports that reconcile cleanly back to source data.
- Experience coaching and mentoring team members to grow their impact as a company scales, rather than primarily building headcount.
- Comfortable operating with significant autonomy in a lean, fast-scaling finance team.
- Genuine motivation to build LLM-based automation and agents is a plus.
- Experience representing a company's position directly to auditors on revenue matters — leading the conversation, not just supporting someone else who does.
Compensation
Actual salaries will vary depending on factors including but not limited to location, experience, and performance. The range listed is just the base salary component of NexHealth’s total compensation package for employees. Other benefits may include stock options, an unlimited paid time off policy, and up to 100% coverage on medical, vision and dental insurance.
Benefits
- Full Medical, Dental, and Vision (up to 100% covered)
- 401K and commuter benefits
- Flexible PTO
- High-impact work that directly improves the healthcare experience for millions
Our Values
- Solve the customer’s problems, not yours
When making decisions, think from the perspective of the customer. It’s easy to make decisions that make our lives simpler, but not the customers. - Do the things others are not willing to do
As a Nexer, always go after the hardest problems. Pursue things at the highest quality. Move at the fastest pace. - Take ownership
Act like a founder. Own your roles, destinies, mistakes, behavior, and our mission. The buck stops with each of us - no blaming or excuses. - Say what’s on your mind, with positive intent
Be direct, proactive, transparent, and frequent in your communication. - Default trust
As a Nexer, you do not have to earn trust, trust is given to you by default. If we by default trust each other, our speed of communication, feedback, information sharing, and overall improvements will be a lot faster. - Think in first principles
We first identify the problem and then break it down to its fundamentals before diving into solutions. We constantly ask “why” to validate our assumptions.
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, sex, gender expression, sexual orientation, age, marital status, veteran status, or disability status. We provide reasonable accommodation for individuals with disabilities to participate in the application or interview process. Contact talent@nexhealth.com to request assistance.
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