Director of Contracts and Compliance 254879

Director of Contracts & Compliance

Location: New York, NY (42nd Street)

Schedule: Hybrid – 4 days onsite, 1 day remote

Conveniently located near major public transportation

Position Overview

We are seeking a Director of Contracts & Compliance to serve as the critical bridge between Managed Care, Revenue Cycle, and Clinical Operations. This individual will ensure payer contracts are negotiated, operationalized, and monitored effectively so the organization receives appropriate reimbursement while maintaining compliance with contractual and regulatory requirements.

This role is ideal for someone who understands both the managed care and revenue cycle sides of healthcare and can translate complex contract terms into actionable processes for clinical, operational, and billing teams.

Key Responsibilities

• Lead negotiation, implementation, and ongoing management of payer and managed care contracts.
• Serve as the primary liaison between Managed Care, Revenue Cycle, and Clinical Operations to ensure contract requirements are understood and executed.
• Interpret contract language and communicate operational, documentation, and reimbursement requirements to clinical and operational teams.
• Partner with Revenue Cycle leadership to ensure claims are adjudicated according to contract terms and reimbursement is aligned with negotiated rates.
• Analyze underpayments, reimbursement variances, denials, and contract performance issues.
• Develop processes to ensure payer contract provisions are effectively translated into workflows and operational practices.
• Collaborate with clinicians and operational leaders to support compliance with payer requirements and quality initiatives.
• Monitor regulatory and compliance requirements related to payer contracts and reimbursement programs.
• Identify opportunities for revenue optimization, contract improvement, and operational efficiencies.
• Support value-based care initiatives, provider enrollment, and payer relationship management efforts.

Qualifications

• 8+ years of healthcare experience within managed care, payer contracting, provider contracting, revenue cycle, reimbursement, or healthcare operations.
• Strong understanding of both professional billing and payer contract administration.
• Experience working directly with clinicians, operational leaders, and revenue cycle teams.
• Demonstrated experience interpreting contract language and ensuring operational execution of contract requirements.
• Knowledge of contract adjudication, reimbursement methodologies, payer policies, and revenue integrity principles.
• Experience analyzing reimbursement performance and resolving contract-related payment issues.
• Bachelor's degree required; Master's degree preferred.

Preferred Background

• Experience within a hospital, health system, physician group, MSO, IPA, ACO, or managed care organization.
• Experience serving as a bridge between contracting and revenue cycle functions.
• Value-based care and population health experience.
• Strong payer relationship management and negotiation experience.

Why Join Us?

• Highly visible leadership role with significant cross-functional impact.
• Opportunity to influence payer strategy, reimbursement performance, and operational excellence.
• Direct partnership with executive leadership, clinical teams, and revenue cycle leadership.
• Convenient Midtown Manhattan location adjacent to major transportation hubs.