Compliance Director

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 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 Minimum of five years of progressive experience in healthcare credentialing, contracting, and payer relations Direct 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 experience Demonstrated history of commercial contract negotiation and credentialing cycle completion Working 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 appeals Experience with CAQH, NCQA standards, and provider data management platforms Familiarity with HIPAA, HITECH, Title 42 CFR Part 2, MHPAEA, and applicable state substance use disorder licensing frameworks Preferred Qualifications Bachelor’s degree in healthcare administration, business administration, or a related field Professional compliance certification such as CHC, CPCO, or CHPC Medicaid and Medicare credentialing and contracting experience Prior management experience leading credentialing or contracting teams #J-18808-Ljbffr SM Staffing