Senior Manager/Director of Revenue Operations
About The Position
Release Recovery is bringing its insurance billing operations fully in-house and is seeking a Senior Manager/Director of Revenue Operations to lead the transition. The role combines leadership with hands-on execution across the revenue cycle, including eligibility verification, utilization review, claims management, payer relations, reimbursement, denial resolution, and billing compliance. The position will build the systems, workflows, team, and infrastructure needed to support the organization’s growth and in-house operations. The role oversees revenue cycle operations across outpatient, partial hospitalization (PHP), intensive outpatient (IOP), and case management services. It maintains accurate and compliant billing practices; monitors performance metrics; manages claims, denials, appeals, and accounts receivable; supports payer relations and contracting; and develops reporting and forecasts. The position also leads billing audits and partners with clinical, operational, legal, and compliance leaders on documentation concerns, payer disputes, and complex escalations.
Requirements
- Proven experience in healthcare revenue cycle management, preferably in behavioral health, substance use treatment, or a related setting.
- Experience building or expanding in-house insurance billing and revenue cycle operations.
- Strong background in insurance billing, claims management, accounts receivable, and denial resolution.
- Ability to develop workflows, establish priorities, and implement solutions in a growing organization.
- Strong understanding of CPT, HCPCS, and ICD-10 coding, payer guidelines, and behavioral health billing requirements.
- Proficiency with EMR/EHR platforms, clearinghouses, and revenue cycle technology.
- Strong analytical and problem-solving skills, with the ability to translate data into operational improvements.
- Working knowledge of HIPAA, applicable OASAS requirements, and federal healthcare billing requirements.
Nice To Haves
- Experience with Kipu, CollabMD, Apero, and QuickBooks is strongly preferred.
Responsibilities
- Manage insurance billing operations from eligibility verification through final reimbursement.
- Build and improve revenue cycle workflows across outpatient, PHP, IOP, and case management services.
- Develop the team and infrastructure needed to support in-house operations.
- Maintain internal controls that support accurate, compliant billing.
- Monitor and improve clean claim rates, days in accounts receivable, authorization approval rates, denial trends, net collection percentages, and reimbursement variances.
- Identify process inefficiencies and implement automation and technology solutions.
- Oversee claim creation, coding accuracy, submission, payment posting, and reconciliation.
- Ensure billing follows applicable CPT, HCPCS, and ICD-10 coding standards for behavioral health services.
- Validate charge capture and supporting documentation before claim submission.
- Manage electronic billing systems, clearinghouses, and electronic health record integrations.
- Maintain current payer billing rules and submission requirements.
- Develop denial prevention and appeal strategies.
- Oversee clinical and administrative appeals in partnership with clinical leadership.
- Analyze denial trends and implement corrective actions.
- Manage accounts receivable follow-up to ensure timely claim resolution.
- Lead reimbursement renegotiation efforts when appropriate.
- Partner with legal, compliance, and clinical leadership on complex escalations and payer disputes.
- Analyze reimbursement rates, fee schedules, and payer contract performance.
- Support payer negotiations through reimbursement analysis, utilization data, and financial modeling.
- Monitor payer policy changes and communicate their operational impact.
- Develop revenue cycle dashboards and operational reports.
- Provide leadership with insights on payer mix, reimbursement trends, collections, and operational performance.
- Forecast revenue using census, payer mix, and authorization utilization.
- Identify and address the causes of revenue leakage and reimbursement delays.
- Ensure revenue cycle practices comply with payer contracts and applicable state and federal requirements.
- Maintain HIPAA compliance and accurate billing and authorization records.
- Lead internal billing audits and support external payer audits.
- Partner with clinical and compliance leadership to address documentation and billing concerns.
Benefits
- Health benefits for full-time employees.
- Dental benefits for full-time employees.
- Vision benefits for full-time employees.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
