Director of Payer Compliance & Quality Assurance

Salary: $120000 - $130000 as year (DOE)

On-Site Position

• Lead organizationwide payer compliance strategy across all levels of care (PHP IOP OP ResidentialAdult & Adolescent)
• Interpret payer policies medical necessity criteria state regulations and accreditation standards (Joint Commission CARF)
• Develop and maintain payer compliance crosswalks aligned to payer regulatory and accreditation requirements
• Design and oversee a companywide QA and payer compliance audit program
• Audit clinical documentation utilization review records and medical necessity support to ensure payer readiness
• Track trend and analyze audit findings to identify risks gaps and performance opportunities
• Build dashboards and scorecards monitoring compliance rates documentation quality and denial trends
• Lead performance improvement initiatives and corrective action plans in collaboration with leadership
• Develop and deliver compliance training tools and workflows for clinical medical and operations teams
• Serve as subject matter expert for payer audits accreditation surveys state inspections and denials prevention efforts

• Masters degree in Behavioral Health Healthcare Administration Nursing or a related field preferred

• • Behavioral health compliance
  • Quality assurance or utilization review
  • Payer or revenue integrity oversight

• Advanced knowledge of:
• • LOCUS criteria and payer medical necessity standards
  • Joint Commission and/or CARF accreditation requirements
  • State and multistate regulatory frameworks

• Access to professional growth using our cutting-edge strategies and trainings with our exceptional leaders.
• Medical Dental & Vision Insurance Multiple plan options including PPO and HDHPs with HSA eligibility and company contributions.
• Paid Parental Leave Up to 6 weeks fully paid for exempt employees and 4 weeks for non-exempt.
• Life & Disability Coverage Company-paid life AD&D and long-term disability; voluntary life and optional short-term disability available.
• 401(k) with Company Match Retirement savings with matching contributions after eligibility period.
• PTO & Holidays Competitive PTO accrual plans and paid holidays throughout the year.
• Employee Assistance Program (EAP) Free confidential support for lifes challenges.

Embark is an Equal Employment Opportunity Employer.We are committed to enriching the therapeutic and healing experience we offer through the diversity of our employees and community. We actively seek to recruit and support a broadly diverse staff who contribute to our excellence diversity of viewpoints and experiences and relevance in a global society.

Embark does not discriminate on the basis of race color religion sex (including pregnancy gender identity and sexual orientation) national origin age disability genetic information marital status veteran status or any other protected status under applicable laws. Accommodations are available for applicants with disabilities.