Compliance Director

Compliance DirectorThe Compliance Director is responsible for credentialing, contracting, and payer-side oversight across the behavioral health and substance use disorder portfolio managed by the company. The position expands to include authorization oversight as the function matures and provides advisory support for broader compliance matters.Core ResponsibilitiesLead provider credentialing and facility contracting across portfolio facilities, including initial credentialing, re-credentialing, and CAQH profile maintenanceNegotiate and manage commercial payer contracts, fee schedules, and renewalsMaintain credentialing status tracking with proactive follow-up to prevent enrollment gapsProvide advisory support on HIPAA, audit response, regulatory inquiries, and Joint Commission / AHCA compliance postureDevelop and lead a small team of credentialing, contracting, and authorization specialists as the portfolio scalesServe as internal subject matter expert on commercial payer policy and behavioral health regulatory developmentsRequired ExperienceMinimum of five years of progressive experience in healthcare credentialing, contracting, and payer relationsDirect hands-on experience on both the payer side (network management, provider relations, contracting, or credentialing at a commercial payer) and the provider side (credentialing, contracting, or related operational roles at a healthcare provider organization)Behavioral health and/or substance use disorder vertical experienceDemonstrated history of commercial contract negotiation and credentialing cycle completionWorking knowledge of major commercial payers and their behavioral health carve-outs (e.g., Optum BH, Magellan, Evernorth, Carelon), including authorization workflows, concurrent review processes, and appealsExperience with CAQH, NCQA standards, and provider data management platformsFamiliarity with HIPAA, HITECH, Title 42 CFR Part 2, MHPAEA, and applicable state substance use disorder licensing frameworksPreferred QualificationsBachelor's degree in healthcare administration, business administration, or a related fieldProfessional compliance certification such as CHC, CPCO, or CHPCMedicaid and Medicare credentialing and contracting experiencePrior management experience leading credentialing or contracting teams