Compliance Director

Job Description

Job Description

*NOW HIRING: Compliance Director*  
Monsey, NY | Full-time | $125k - $150k

*Position Overview*  
The *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 Responsibilities for the Compliance Director*  
— Lead provider credentialing and facility contracting across portfolio facilities, including initial credentialing, re-credentialing, and CAQH profile maintenance  
— Negotiate and manage commercial payer contracts, fee schedules, and renewals  
— Maintain credentialing status tracking with proactive follow-up to prevent enrollment gaps  
— Provide advisory support on HIPAA, audit response, regulatory inquiries, and Joint Commission / AHCA compliance posture  
— Develop and lead a small team of credentialing, contracting, and authorization specialists as the portfolio scales  
— Serve as internal subject matter expert on commercial payer policy and behavioral health regulatory developments  

*Required Experience*  
We need a *Compliance Director* with minimum five years of progressive experience in healthcare credentialing, contracting, and payer relations. Direct hands-on experience on both the payer side and provider side is required, plus behavioral health and/or substance use disorder vertical experience.

Other must-haves for the *Compliance Director* role:  
— Demonstrated history of commercial contract negotiation and credentialing cycle completion  
— Working knowledge of major commercial payers and their BH carve-outs: Optum BH, Magellan, Evernorth, Carelon  
— Experience with CAQH, NCQA standards, and provider data management platforms  
— Familiarity with HIPAA, HITECH, Title 42 CFR Part 2, MHPAEA, and applicable state SUD licensing frameworks  

*Preferred Qualifications*  
— Bachelor’s degree in healthcare admin, business admin, or related field  
— Professional compliance certification: CHC, CPCO, or CHPC  
— Medicaid and Medicare credentialing and contracting experience  
— Prior management experience leading credentialing or contracting teams
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