Licensed Director of Payer Compliance

Job Summary

A company is looking for a Director of Payer Compliance.

Key Responsibilities

• Lead the development of strategies to align clinical programming with payer requirements across all levels of care
• Interpret payer-specific policies and ensure organizational readiness for payer reviews and reimbursement
• Conduct audits of clinical documentation and implement solutions to improve documentation quality and revenue capture

Required 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 experience in behavioral health operations, utilization review, or revenue cycle
• Deep expertise in payer-specific medical necessity criteria and insurance requirements
• Proven ability to analyze data and implement process improvements related to financial performance