Insurance Compliance Officer

Insurance Compliance Officer

Footprints Mental Health Counseling, P.C.

Title: Insurance Compliance Officer

Department: Compliance

Schedule 9am – 5pm EST

Rate: Flexible

The goal of this position is to prevent insurance companies from disallowing claims due to the practice’s failure to comply with regulatory requirements. The Compliance Officer ensures that if and when audited by any governing body, that we are in compliance with all rules and regulations. This includes the licensing board, office of Medicaid, all insurance panels, department of labor and internal revenue system. The position will mainly focus on compliance with our “payers”, however any compliance tasks in regards to any governing body may be asked of the compliance officer.

Key Responsibilities

Billing & Coding Compliance

• Ensure all staff members are properly educated on CPT codes, including which codes should and should not be used.

• Monitor and address overbilling concerns, particularly related to CPT code 90837, and ensure appropriate use of 90834 when required.

• Cancel or void claims that are billed incorrectly or reported by clients as not occurring; investigate all such incidents promptly.

• Prevent insurance recoupment through proactive audits, education, and corrective action.

• Address and respond to insurance company inquiries related to billing practices, overbilling, or audits.

Oversight

• Ensure interns are billing only Medicaid or other insurances that have approved supervisee billing.

• Confirm interns are billing under the correct CPT codes and within payer guidelines.

• Manage supervision-related compliance, including documentation of supervision hours and licensure-related paperwork as applicable.

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Clinical Documentation & Quality Assurance

• Ensure intake sessions are conducted correctly and documented appropriately.

• Ensure all treatment plans are active, updated at least every three months, and properly signed by clients.

• Monitor the overall quality of clinical notes to ensure accuracy, completeness, and compliance with payer and regulatory standards.

• Ensure all clinical documentation adheres to guidelines set forth by governing bodies, Medicaid, Optum, and other payers.

Fraud Prevention & Risk Management

• Regularly review sessions and documentation for potential fraud or unethical behavior.

• Immediately escalate and address suspected fraud, including terminating providers when necessary and resolving issues through claim voiding and corrective action.

Medicaid & Payer-Specific Compliance

• Ensure all Medicaid cases are following Medicaid protocols and requirements.

• Ensure adherence to Optum guidelines and any other payer-specific rules.

• Serve as a subject matter expert on payer policies and compliance requirements.

Policy Development & Cross-Department Collaboration

• Create and maintain billing and insurance compliance best-practice guidelines for all staff.

• Provide training and ongoing education to clinicians, interns, and administrative staff.

• Work closely with the billing department and intake department to ensure organization-wide compliance and consistency.

Qualifications

• Bachelor’s degree in healthcare administration, health information management, business, or a related field required; advanced degree preferred • 2+ years of experience in insurance billing, compliance, utilization review, or healthcare revenue cycle management (behavioral health preferred) • Strong working knowledge of CPT codes, documentation standards, and insurance billing requirements, including Medicaid and commercial payers • Demonstrated experience preventing recoupment and addressing payer audits, denials, and disallowments • Ability to review clinical documentation for quality, accuracy, and compliance with payer and regulatory standards • Strong understanding of insurance coverage details, including deductibles, copayments, coinsurance, and authorization requirements • Ability to understand and differentiate mental health degree types and licensure levels, including interns, limited permit providers, and fully licensed clinicians (e.g., MHC Intern, MHC-LP, LMHC, LCSW, LMSW, PhD, PsyD, LMFT, etc.) • Ability to understand a wide range of mental health diagnoses and treatment modalities, including but not limited to bipolar disorder, major depressive disorder, anxiety disorders, PTSD, CBT, DBT, and psychodynamic therapy • Excellent attention to detail with the ability to identify compliance risks, billing errors, and potential fraud • Strong organizational and documentation skills, with the ability to manage multiple cases, providers, and compliance tasks simultaneously • Excellent customer service skills and a collaborative mindset, with the ability to work effectively with clinicians, interns, billing staff, intake teams, and leadership • Ability to communicate clearly and professionally when providing education, feedback, and corrective guidance to staff • Experience creating policies, procedures, and best practice guidelines related to billing and compliance

Why Join Us

• Fully remote leadership role (India & Philippines)
• Direct impact on organizational integrity and growth
• Opportunity to build and lead a compliance team
• Stable, long-term position with advancement potential
• Mission-driven organization focused on ethical mental health care

How to Apply

Apply through Indeed with your updated resume.Qualified candidates will be contacted for interviews.

If compliance is your strength and leadership is your calling, this role gives you both.

Job Type: Full-time

Pay: From ₹25,000.00 per month

Work Location: Remote