Head of Compliance Operations (Remote)

Remote

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. The Director 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, and compliance oversight.

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

Net collection percentages

Reimbursement variance analysis

Identify process inefficiencies and implement automation and technology solutions to improve operational performance.

Ensure timely and accurate submission of clinical documentation supporting medical necessity and level of care.

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

Lead reimbursement renegotiation efforts with payers when appropriate.Oversee all insurance appeals, including both clinical and administrative appeals.

Supervise A/R follow-up processes to ensure timely claim resolution.

Collaborate with legal, compliance, and clinical leadership on complex escalations and payer disputes.

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.

Provide leadership with insights related to payer mix, reimbursement trends, collections performance, and operational KPIs.

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.

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.

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. 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.

At Release, recovery is about growth, connection, and long-term transformation.

Be eligible for health, dental, and vision benefits (full-time employees)