Payer Compliance Administrator (Remote in the United States)

Full-time Exempt

Direct Hire

100% Remote

$$80,000 - $95,000 per year

About Expressable:

Expressable is a virtual speech therapy practice on a mission to transform care delivery and expand access to high-quality services, serving thousands of clients since our inception in late 2019. We are passionate advocates of parent-focused intervention. Our e-learning platform contains thousands of home-based learning modules authored by our clinical team, helping SLPs empower caregivers to integrate speech therapy techniques into their child’s daily life and improve outcomes. Our mission is to set a new standard in speech therapy by making every caregiver a champion of their loved one’s success. We envision a world where everyone can fulfill their communication potential.

About the Role:

We are looking for a Payer Compliance Administrator with strong project management and communication skills to join our growing team. You will be responsible for internal compliance with new and existing payer contracts. This role monitors and documents payer policies and regulatory standards while overseeing the implementation and adherence to payer-specific requirements. This position is also responsible for coordinating and managing external payer audits and conducting monthly compliance audits, with a focus on telehealth and treatment policies.

We are interested in every qualified candidate who is eligible to work in the United States. However, we are not able to sponsor visas at this time.

What you would be doing at Expressable

• NEW PAYER REVIEW AND SETUP
• Assess and ensure readiness for onboarding new payers.
• Review and verify that all necessary documentation and systems are in place for new payers including enrollments and collaboration with revenue cycle management partners. 
• Oversee the setup process for new payers, ensuring accurate setup including modifiers, exclusions, and portal access.
• Ensure that user access and payer-specific configurations are correctly established in internal and external systems.
• DOCUMENTATION COMPLIANCE
• Maintain up-to-date documentation standards in line with payer requirements.
• Partner with department leaders to provide payer-specific training and ensure adherence to compliance rules.
• Ensure all processes and policies are properly documented and compliance is maintained. 
• Lead and manage audits assigned by health plans or external organizations, ensuring timely and accurate responses.
• Coordinate with Quality teams to meet payer billing and documentation requirements for audits.
• PAYER/PROCESS TRAINING
• Develop and deliver training programs related to payer processes and compliance for relevant departments.
• Ensure all staff are informed of and trained on new regulations and payer-specific requirements.
• Create, distribute, and track all required Payer training and compliance requirements for company employees. 
• REGULATORY MONITORING
• Continuously monitor changes in insurance payer regulations and standards.
• Ensure the organization remains compliant with state-specific laws, particularly in telehealth and treatment.
• MONTHLY COMPLIANCE AUDITS
• Conduct regular audits to identify and address potential compliance risks in client claims, insurance, and clinical documentation. 
• Prepare recommendations for corrective action based on audit findings for department leaders. 
• Review and document insurance requirements with accuracy and ensure contract compliance.
• Create and update information in electronic health records and CRM.
• Properly escalate items needing attention.
• Ensure work is performed in compliance with company policies including HIPAA and other regulatory, legal, and safety requirements.r regulatory, legal and safety requirements.

What you bring to Expressable

• bachelor’s degree in healthcare administration, business, or a related field.
• 5+ years experience in payer enrollment, documentation compliance, and audit management. Revenue cycle management management experience preferred.
• Clinical experience preferred.
• Strong knowledge of insurance payer regulations and state-specific telehealth laws.
• experience with and competency in office productivity and collaboration tools such as MSOffice/Teams or Google Suite and Slack. Familiarity with Salesforce or other CRM platforms.
• Excellent project management and communication skills.
• Ability to collaborate effectively with cross-functional teams.
• Ability to collaborate with a fully remote team

Key competencies for success in this role

• Written and Oral Communication: Writes clearly and informatively. Edits work for spelling and grammar. Varies writing style and channel of written communication to meet needs. Presents numerical data effectively. Able to read and interpret written information. Speaks clearly and persuasively in positive or negative situations. Listens and gets clarification. Responds well to questions. Demonstrates group presentation skills tailoring message for a variety of audiences. Participates actively and effectively in meetings.
• Attention to Detail: Double-checks the accuracy of information and work product to provide accurate and consistent work. Provides information on a timely basis and in a usable form to others who need to act on it. Carefully monitors the details and quality of one's own and others' work.
• Project Management: Develops project plans. Coordinates projects. Communicates changes and progress. Completes projects on time and within budget. Manages project team activities.
• Investigation: Possesses the ability to examine a situation closely and discover items of importance that may not have been readily apparent. Collects relevant data and derives conclusions from the information gathered.
• Risk Management: Possess relevant regulatory knowledge and business understanding and demonstrates the ability to quantify risks, identify known and potential risks, and plan risk management approaches.

Benefits at Expressable

• Exceptional paid time off policies that encourage and support life balance
• 401k matching to ensure our staff have what they need to enjoy their retirement
• Health insurance options that ensure well being for the whole person and their family
• Company provided hardware and software for home office
• Remote work environment that strives for connectivity through professional collaboration and personal connections

Expressable values people. From the technology we develop, the services we provide, and the culture we maintain, Expressable cares about the experience of our employees, clients, and prospects. We intentionally create and sustain supportive environments in which everyone - clients, caregivers, speech-language pathologists, and team members - can achieve their highest potential.

We believe that building trusting and collaborative relationships is paramount to delivering quality care so we operate with the highest levels of honesty, transparency, and accountability as individuals and a collaborative team. We believe that transforming therapy happens through the steady and iterative problem solving of an interdisciplinary team.

Expressable is an equal opportunity workplace. We celebrate and embrace diversity and are committed to building a team that represents a broad tapestry of backgrounds, perspectives, and skills.

Expressable is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Expressable will take the steps to ensure people with disabilities are provided reasonable accommodations. Accordingly, if reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact our HR Director at [email protected].