Compliance Director

Job Description

Compliance Director | SNFout

The Tone:
This is a full-time role at SNFout, located in Monsey, NY. SNFout manages a growing portfolio of facilities specializing in behavioral health and substance use disorder services. This Compliance Director role is crucial for establishing and maintaining robust credentialing, contracting, and payer oversight across the entire portfolio, ensuring operational efficiency and supporting the company’s expansion in a highly regulated environment.

The TL;DR
• Role: Full Time
• Type: Full-time
• Location: In-person, Monsey, NY
• Pay: $125000–$150000 yearly
• Team: Leads a small team of credentialing, contracting, and authorization specialists.
• Mission: Owns credentialing, contracting, and payer-side oversight for the company’s behavioral health and substance use disorder portfolio.
• Tech Stack: CAQH, NCQA standards, provider data management platforms

What You’ll Actually Do
• Credentialing: Lead all aspects of provider credentialing and facility contracting for the portfolio.
• Contracting: Negotiate and manage commercial payer contracts, fee schedules, and renewals.
• Oversight: Maintain vigilant tracking of credentialing statuses to proactively prevent any enrollment gaps.
• Advisory: Provide expert advisory support on HIPAA, audit responses, regulatory inquiries, and compliance posture.
• Team Leadership: Develop and lead a small team of specialists as the company’s portfolio expands.

The Must-Haves
• Background: Director level experience with a strong, progressive career in healthcare credentialing, contracting, and payer relations. Direct experience within the behavioral health and/or substance use disorder vertical is essential for success in this role.
• Experience: Minimum five years of progressive experience, demonstrating a clear history of successful commercial contract negotiation and comprehensive credentialing cycle completion. Direct hands-on experience on both the payer and provider sides of healthcare is a mandatory requirement.
• Skills: Expertise in the intricacies of major commercial payers and their specific behavioral health carve-outs, including Optum BH, Magellan, Evernorth, and Carelon. Proficiency with industry-standard platforms such as CAQH, NCQA standards, and various provider data management systems. Strong familiarity with critical regulatory frameworks including HIPAA, HITECH, Title 42 CFR Part 2, MHPAEA, and applicable state SUD licensing frameworks.
• Bonus: A Bachelor’s degree in healthcare administration, business administration, or a related field. Professional compliance certification, such as CHC, CPCO, or CHPC, is highly valued. Additional experience with Medicaid and Medicare credentialing and contracting processes. Prior management experience specifically leading credentialing or contracting teams.