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
As our Senior Accounting Manager, you’ll own the accuracy and speed of NexHealth’s books and reinvent how that work gets done. You’ll bring the discipline of a mature close and pair it with modern data and AI tooling, so that a fast, auditable close becomes the default rather than a monthly sprint. This role is a fit for an accountant who has run a strong close before and wants to build the next version of it.
What You’ll Do
- Own the month-end close end to end, including the calendar, owners, dependencies, and sign-off, and drive it toward a 4-business-day close
- Lead our offshore accounting team: set priorities, review their work, and hand off close tasks, reconciliations, and recurring accounting work with clear checklists and turnaround expectations
- Own the quality of GAAP financial statements across every account by setting review standards for flux analysis and balance sheet reconciliations
- Design and ship automation and AI agents for core accounting work, such as reconciliations, flux commentary, journal entry preparation, anomaly detection, and close tracking
- Own payroll accounting and operations in Rippling, including international hires through our employer of record partner, with accurate accruals, reconciliations, and strong payroll controls
- Partner on equity management in Carta, including grant and exercise processing, cap table reconciliation to the general ledger, and stock-based compensation
- Build financial and operational reporting and dashboards in Sigma that leadership uses to run the business
- Partner with Data Science to build and improve our finance data warehouse in Snowflake, so reconciliations, close checks, and reporting run on trusted, reconcilable data
- Lead audit readiness with our external auditors: build the schedules, keep workpapers current, and close auditor requests on time without a last-minute scramble
- Surface risks, control gaps, and process issues early, and document decisions so the team and the systems you build can scale
What You’ll Bring
- Strong experience running the month-end close at a scaling SaaS, payments, or technology company, with solid working knowledge of US GAAP, accruals, and multi-entity accounting
- An active CPA license
- Experience leading offshore or distributed accounting teams across time zones, including setting clear standards and reviewing work for quality
- A track record of building automation with LLMs or agentic workflow tools; you can walk us through something you built and the impact it had
- Strong grasp of internal controls, data completeness, and audit trail design, with processes built to hold up as transaction volume and complexity grow
- Strong SQL skills and hands-on experience with Snowflake or a similar data warehouse; you write your own queries rather than waiting on a data request
- Hands-on experience with NetSuite, plus payroll (Rippling or similar), spend management (Ramp or similar), BI (Sigma, Looker, or similar), and cap table (Carta or similar) platforms
- Comfort with technical accounting research, getting to the root of an issue and turning conclusions into practical policies and entries
- Sound judgment with imperfect data: you make the call, keep the close moving, then fix the underlying data so the issue doesn’t come back
- Clear communication with Data Science, Engineering, Revenue Operations, and Finance partners, adapting to technical and leadership audiences and documenting decisions so others can learn how things work
- A drive to rethink how corporate accounting works with LLMs and agentic workflows, paired with a willingness to take on the unglamorous problems that make the business run better
Bonus Points For
- Big 4 or other public accounting experience
- Experience at a fast-growing SaaS business through multiple stages of scale
- Experience with payroll accounting for international teams through an employer of record
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.
NexHealth Compensation Range
$140,000—$160,000 USD
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 [email protected] to request assistance.
