Corporate Director of Admissions and Payor Relations

Caron Treatment Centers•Wernersville, PA

10d

About The Position

The Corporate Director of Admissions and Payor Relations leads admissions, call center, intake, verification of benefits (VOB), utilization review (UR), and financial clearance operations across Caron’s programs and levels of care. The role sets departmental goals, performance metrics, service standards, policies, and procedures, and improves workflows, efficiency, accuracy, call conversion, census growth, and client experience. The director oversees staffing and coverage seven days per week, including evenings, weekends, and holidays as applicable, and may participate in an on-call rotation. The director oversees call center operations and technology, admissions and intake from initial inquiry through admission and placement, benefit verification, financial clearance, utilization review, denial management, and appeals. The role collaborates with clinical, medical, IT, marketing, business development, and revenue cycle teams to support appropriate placement, payer compliance, revenue integrity, referral growth, and a positive patient and family experience. The director analyzes operational and financial performance, presents reports to executive leadership, supports budgeting and resource management, and oversees financial aid allocation and related policy compliance.

Requirements

Bachelor’s degree in healthcare administration, business administration, behavioral health, social work, psychology, counseling, or a related field.
Five years of experience in the chemical dependency field, with working knowledge of addiction.
Five years of experience in a healthcare call center, patient access, intake, or admissions environment, including direct oversight of call center operations, staffing, and performance metrics.
Three years of hands-on experience performing and overseeing verification of benefits, pre-authorization, and financial clearance.
Three years of experience in utilization review or utilization management, including concurrent review, denial management, and appeals.
Experience with call center technology, including ACD/telephony, IVR, call recording, and workforce management, and with CRM platforms.
Five years of progressive leadership experience and at least three years of supervisory or management experience.
Familiarity with CARF accreditation standards and state licensure.
Demonstrated leadership, coaching, and team development skills; strong interpersonal, communication, customer service, problem-solving, organizational, and decision-making abilities.
Expert knowledge of VOB, benefit interpretation, coordination of benefits, network status, patient financial responsibility, utilization review and management, medical necessity criteria, payer authorization requirements, and denial and appeal processes.
Advanced knowledge of call center operations, workforce management, service-level metrics, and quality assurance practices.
Knowledge of commercial, managed care, Medicare, and Medicaid payer requirements and the No Surprises Act.
Ability to analyze operational and financial data and develop actionable solutions; financial sophistication in following financial policies and procedures.
Knowledge of ASAM Criteria, levels of care, SUD treatment services, behavioral healthcare systems, HIPAA, 42 CFR Part 2, and applicable behavioral healthcare regulations.
Proficiency with electronic health records, Salesforce, payer portals and eligibility tools, call center reporting systems, and Microsoft Office applications.
Ability to communicate effectively and use office equipment for extended periods; ability to sit, stand, walk, and travel between organizational locations as required.

Nice To Haves

Master’s degree.
Licensed behavioral health professional, such as LPC, LCSW, LMFT, CAADC, CADC, or equivalent.
Experience with nonprofit healthcare or substance use disorder treatment.
Experience leading multi-site admissions operations.
Certified Healthcare Access Manager (CHAM) or utilization review certification.
Two years of continuous sobriety if in recovery.

Responsibilities

Direct, supervise, train, and develop admissions call center, intake, VOB, UR, and financial clearance staff; ensure adequate staffing, scheduling, and coverage.
Establish departmental goals, performance metrics, service standards, admissions policies, and procedures consistent with organizational objectives, state regulations, CARF standards, and best practices.
Monitor and improve admissions workflows and analyze trends to improve efficiency, accuracy, call conversion, census growth, and client experience.
Direct daily call center operations, including inbound and outbound calls, call routing, queue management, callbacks, after-hours coverage, Live Chat, and online inquiries.
Set and monitor call center KPIs; use workforce management principles and real-time and historical data to forecast volume and adjust staffing.
Oversee call center technology, including ACD/telephony, IVR, call recording, call tracking, and Salesforce CRM, in partnership with IT.
Implement call quality assurance, monitoring, scorecards, coaching, calibration, scripts, call flows, and training that incorporates motivational interviewing, crisis and escalation protocols, HIPAA, and 42 CFR Part 2 requirements.
Oversee intake from initial inquiry through admission and program placement, including bed management and tier scheduling; ensure prompt responses to referrals and service inquiries.
Facilitate screening and assessment for eligibility and level of care in collaboration with clinical leadership, aligning placement with ASAM criteria, clinical recommendations, and organizational capabilities.
Ensure accurate admissions documentation in the electronic health record and related systems, and coordinate admissions communications across departments.
Address complex admissions cases, placement barriers, and escalated concerns.
Provide VOB subject matter expertise, oversight, training, and final review for commercial, managed care, Medicare, Medicaid, EAP, and self-pay populations.
Ensure complete and accurate pre-admission benefit verification, including eligibility, coverage, cost-sharing, network status, exclusions, coordination of benefits, behavioral health carve-outs, and coverage across levels of care; communicate financial responsibility to patients, families, and referents.
Oversee financial clearance, including verification, authorization, patient responsibility estimates, deposits, payment arrangements, single case agreements, financial assistance eligibility, and Good Faith Estimate requirements.
Develop and maintain VOB and financial clearance policies, workflows, and quality audits to minimize denials, write-offs, and accounts receivable risk; maintain knowledge of payer policies, contract terms, and network status.
Oversee timely utilization review, including pre-certification, concurrent review, and discharge review; monitor authorization status and approved days to prevent coverage lapses and unauthorized days.
Ensure authorization submissions support medical necessity under ASAM and payer-specific criteria; educate clinical teams on documentation requirements for continued stay.
Oversee denial management and appeals, including peer-to-peer reviews, expedited appeals, and retrospective reviews, with clinical and medical leadership.
Track UR metrics and implement improvements to reduce denials; ensure payer communications comply with HIPAA and 42 CFR Part 2 requirements.
Collaborate with marketing and business development to increase community awareness and referrals, and monitor referral activity for service expansion and partnership opportunities.
Monitor admissions, call center, referral, VOB, authorization, denial, occupancy, and census performance; prepare and present reports to executive leadership and use data to assess staff competencies and staffing patterns.
Monitor financial planning and financial aid allocation against census and budget goals, including yearly restricted funding, and ensure compliance with corporate financial award policy.
Collaborate with revenue cycle and clinical teams to ensure accurate payer data, clean claims, and alignment between verification, authorization, and billing.
Support departmental budget development and responsible resource management.
Communicate effectively in person, by phone, and electronically; ambulate on campuses to facilitate tours; travel between organizational locations as required; participate in on-call rotation when needed.