Director of Payer Compliance

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

Location: Remote
Reporting to: Chief Financial Officer

• Lead the development of enterprise-wide strategies to align operations and clinical programming to align with payer requirements across all levels of care (PHP IOP OP Residential; Adult & Adolescent)
• Interpret and operationalize payer-specific policies medical necessity criteria and reimbursement requirements across multiple insurance providers
• Design implement and continuously refine systems and processes that ensure organizational readiness for payer review and reimbursement
• Conduct targeted audits of clinical documentation utilization review practices and workflows to ensure alignment with payer expectations
• Identify gaps in current processes and implement solutions that improve documentation quality payer alignment and revenue capture
• Track and analyze key performance indicators including denial trends documentation accuracy and payer-specific outcomes
• Develop dashboards and reporting tools to provide visibility into payer performance and organizational effectiveness
• Partner cross-functionally with finance billing clinical leadership and operations to drive continuous improvement and reduce reimbursement risk
• Lead initiatives to enhance documentation standards and support medical necessity justification
• Provide expertise during payer audits reviews and appeals processes to support optimal reimbursement outcomes
• Design and deliver training tools and guidance to ensure teams understand and meet payer expectations.

• Masters degree in Behavioral Health Healthcare Administration Nursing or related field preferred
• Independent clinical licensure (e.g. LMHC LCSW LPC RN) strongly preferred
• 57 years of progressive experience in:
  • Behavioral health operations utilization review or revenue cycle
  • Working directly with insurance payers and reimbursement requirements
  • Payer strategy revenue integrity or documentation quality initiatives

• Deep expertise in payer-specific medical necessity criteria and insurance requirements across multiple payers
• Strong experience building systems workflows and audit processes that improve reimbursement outcomes
• Proven ability to analyze data identify trends and implement process improvements tied to financial and operational performance
• Strong cross-functional leadership skills with the ability to influence clinical operational and financial stakeholders.

• 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.