Director / Vice President of Revenue Operations
Location
United States
Posted
43 days ago
Salary
$125K - $165K / year
Seniority
Lead
No structured requirement data.
Job Description
Director / Vice President of Revenue Operations
Release Recovery
Role Description This is a rare opportunity to step into a high-impact leadership role at the ground floor. We are bringing our revenue cycle operations fully in-house and are looking for an entrepreneurial, forward-thinking leader who is energized by building from 0 → 1, driving innovation, and owning results end to end. Release Recovery is seeking someone who thrives in a growth environment and wants their work to have a direct and lasting impact on the organization. The Director/Vice President of Revenue Operations will lead the transition of Release Recovery’s insurance billing operations fully in-house, building the systems, workflows, infrastructure, and team needed to support a scalable, high-performing revenue cycle operation. This individual will oversee the full lifecycle of billing and reimbursement operations across all programs and service lines, including: - Utilization review - Claims management - Payer relations - Reimbursement optimization - Denial management - Compliance oversight Primary Responsibilities: - Revenue Cycle Leadership: - Build, own, and manage the full lifecycle of insurance billing operations from eligibility verification through final reimbursement. - Develop, implement, and optimize revenue cycle workflows across residential, outpatient, PHP/IOP, and case management services. - Establish internal controls to ensure accurate, compliant, and scalable billing practices. - Monitor and improve key performance indicators including: - Clean claim rate - Days in A/R - Authorization approval rates - Denial trends - Net collection percentages - Reimbursement variance analysis - Identify process inefficiencies and implement automation and technology solutions to improve operational performance. - Utilization Review & Authorizations: - Oversee authorization strategy and utilization review processes across all levels of care. - Ensure timely and accurate submission of clinical documentation supporting medical necessity and level of care. - Partner closely with clinical leadership to align documentation practices with payer requirements. - Monitor authorization utilization and proactively prevent lapses in coverage. - Train and support UR staff and clinical teams on payer guidelines and documentation standards. - Claims Management & Billing Operations: - Own the full claims cycle including claim creation, coding accuracy, submission, and reconciliation. - Ensure compliance with CPT, HCPCS, and ICD-10 coding standards specific to behavioral health services. - Validate charge capture and supporting documentation prior to claim submission. - Manage electronic billing systems, clearinghouses, and EMR integrations. - Maintain payer billing rule libraries and submission requirements. - Denials, Appeals & Accounts Receivable: - Develop and execute denial prevention and appeal strategies. - Lead reimbursement renegotiation efforts with payers when appropriate. - Oversee all insurance appeals, including both clinical and administrative appeals. - Analyze denial trends and implement corrective action plans. - Supervise A/R follow-up processes to ensure timely claim resolution. - Collaborate with legal, compliance, and clinical leadership on complex escalations and payer disputes. - Payer Relations & Contracting Support: - Analyze reimbursement rates, fee schedules, and payer contract performance. - Support and participate in payer negotiations through reimbursement analysis, utilization data, and financial modeling. - Identify opportunities for contract optimization and improved reimbursement structures. - Monitor payer policy updates and communicate operational impacts internally. - Reporting & Analytics: - Build and oversee revenue cycle dashboards and operational reporting. - Provide leadership with insights related to payer mix, reimbursement trends, collections performance, and operational KPIs. - Forecast revenue based on census, payer mix, and authorization utilization. - Conduct root-cause analysis related to revenue leakage and reimbursement delays. - Compliance & Regulatory Oversight: - Ensure compliance with payer contracts, state licensing requirements, and federal billing regulations. - Maintain adherence to HIPAA, behavioral health billing regulations, and audit readiness standards. - Lead internal billing audits and support external payer audits as needed. - Maintain accurate documentation and audit trails for billing and authorization activities. Qualifications - Proven experience in healthcare revenue cycle management, preferably within behavioral health, substance use treatment, or a related healthcare setting. - Strong background in insurance billing, utilization review, claims management, and denial resolution. - Experience building, scaling, or transitioning billing operations in-house. - Entrepreneurial mindset with the ability to develop and execute solutions in a fast-paced, growth-oriented environment. - Demonstrated leadership experience with the ability to build, train, and develop high-performing teams. - Deep understanding of CPT, HCPCS, and ICD-10 coding, payer guidelines, and behavioral health billing requirements. - Proficiency with EMR/EHR platforms, clearinghouses, and revenue cycle technologies. Experience with Kipu, CollabMD, and QuickBooks strongly preferred. - Strong analytical and operational problem-solving skills with the ability to turn data into actionable strategy. - Working knowledge of HIPAA, OASAS, and federal healthcare billing compliance requirements. Benefits - Work alongside respected thought leaders in the recovery space. - Make a direct, meaningful impact on individuals and families. - Receive compensation commensurate with experience (salary range: $125,000 - 165,000). - Be eligible for health, dental, and vision benefits (full-time employees).
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