Remote Utilization Management Jobs in Reston, VA

Locations: Washington, DC; New York, NY; Austin, TX; 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. 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 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
• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.
• 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.

Joining our team means being part of a mission-driven organization redefining how the world views and treats substance use and mental health. At Release, recovery is about growth, connection, and long-term transformation.

When you join our team, you will:

• 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)

We believe recovery is a journey, not a destination, and we’re committed to shaping that journey with intention, care, and innovation.