[Hiring] Director of Payer Compliance @Embark Behavioral Health

Role Description

The Director of Payer Compliance is a senior leadership role responsible for ensuring that clinical programming and documentation is in compliance with payor requirements and applicable governmental regulations across all levels of care, including PHP, IOP, OP, Residential, and Adolescent Services. This role provides strategic oversight and hands-on leadership in the development, implementation, and continuous monitoring of clinical programming from admit to discharge.

• Lead the development of enterprise-wide strategies to align operations and clinical programming 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.

Qualifications

• Master’s degree in Behavioral Health, Healthcare Administration, Nursing, or related field preferred.
• Independent clinical licensure (e.g., LMHC, LCSW, LPC, RN) strongly preferred.
• 5–7+ 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.

Benefits

• 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 life’s challenges.