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Contract Behavioral Health Compliance

2 weeks ago

Remote, Oregon, United States Pastoral Counseling Services of the South Shore Full time

The Contract Behavioral Health Compliance & Insurance Specialist provides expert support to a private group practice of approximately 25 clinicians by ensuring all billing and compliance activities align with current payer and regulatory standards. This role serves as a liaison between the Clinical Director and the insurance biller—acting as a second set of eyes on insurance interpretation, policy updates, and compliance procedures. The specialist helps the Clinical Director review and understand complex insurance and Medicare documentation, supports billing accuracy, and assists the practice in maintaining compliance and readiness for audits.

Key Responsibilities

  • Review, interpret, and summarize changes in insurance policies, Medicare regulations, and payer requirements affecting behavioral health services.
  • Collaborate closely with the insurance biller to verify correct interpretation and application of payer policies, serving as a second set of eyes for accuracy and compliance.
  • Support the Clinical Director by clarifying and translating complex insurance documents and policy updates into clear, actionable guidance.
  • Provide assistance to the office manager regarding insurance questions
  • Support oversight of the insurance section of the wait-list to ensure potential clients are placed in the correct category depending on type of provider that can accept each insurance
  • Advise intake team on which clinicians can bill specific insurance plans based on licensure, supervision, and credentialing status.
  • Assist in preparing for and responding to payer audits or compliance reviews.
  • Act as the practice's resource for PsyD, LMHC, LICSW, LMFT insurance, billing, and compliance questions.
  • Collaborate with billing personnel and leadership to troubleshoot claims or reimbursement issues.
  • Create easy-to-understand summaries or cheat sheets to help clinicians and administrative staff stay informed about insurance and compliance changes.

Qualifications

  • Bachelor's degree in Health Administration, Behavioral Health, or related field (Master's preferred).
  • Minimum 3 years of experience in behavioral health billing, compliance, or payer relations.
  • In-depth understanding of Medicare, Medicaid, and commercial behavioral health insurance requirements.
  • Familiarity with licensure and supervision standards for PsyD, LMFT, LICSW, LMHC and other behavioral health providers.
  • Excellent analytical, organizational, and communication skills.
  • Ability to interpret complex payer language and translate it into practical guidance for clinical and administrative teams.

Job Type: Contract

Pay: $ $75.00 per hour

Expected hours: 1 – 4 per week

Benefits:

  • 401(k)
  • 401(k) matching
  • Flexible schedule

Work Location: Remote