Director of Clinical Compliance

Role

Reporting to the Head of People, the Director of Clinical Compliance will lead the development, implementation, and oversight of Steadfast Health's payer and regulatory compliance program. This individual will ensure adherence to federal and state healthcare regulations, payer requirements, and industry best practices, while supporting the organization's mission to deliver high-quality, evidence-based SUD treatment. The role will collaborate closely with clinical, operational, legal, and executive leadership to mitigate risk, maintain accreditation standards, and foster a culture of compliance.

Responsibilities

• Regulatory Compliance Management: Ensure compliance with all federal and state regulations, including CMS, HIPAA, 42 CFR Part 2, and other relevant laws governing behavioral health and SUD treatment.
• Payer Compliance & Contracting: Oversee compliance with commercial and government payer requirements, including billing, documentation, and prior authorization protocols. Work with revenue cycle teams to ensure accurate claims submission and mitigate audit risks.
• Policy Development & Implementation: Develop and maintain policies and procedures that support regulatory and payer compliance. Provide training and guidance to staff on compliance-related topics.
• Audit & Monitoring: Design and oversee internal audit processes to proactively identify compliance risks. Coordinate responses to external audits, investigations, and payer inquiries.
• Accreditation & Licensing: Lead efforts to achieve and maintain required accreditations (e.g., CARF, Joint Commission) and ensure proper state licensing for clinics and providers.
• Risk Assessment & Incident Response: Establish processes for identifying, assessing, and mitigating compliance risks. Lead investigations into potential compliance issues and coordinate corrective actions.
• Training & Education: Develop and deliver compliance training programs for clinical and administrative staff to ensure a culture of regulatory awareness and ethical decision-making.
• Collaboration & Reporting: Serve as a key compliance resource to senior leadership, clinical teams, and legal counsel. Provide regular reports to the executive team and board on compliance activities, risks, and mitigation strategies.

Qualifications

• Bachelor's degree required; Master's in Healthcare Administration, Public Health, or related field a plus.
• 7 years of experience in healthcare compliance, regulatory affairs, or payer compliance, preferably in behavioral health, substance use disorder treatment, or a multi-state healthcare organization.
• Expertise in Medicare, Medicaid, and commercial payer regulations, as well as HIPAA and 42 CFR Part 2.
• Strong knowledge of accreditation and licensing requirements for SUD treatment providers.
• Experience managing audits, investigations, and payer relations.
• Exceptional leadership, communication, and problem-solving skills.
• Compliance certification (e.g., CHC, CPCO) preferred.

Physical Requirements

• Prolonged periods of sitting at a desk and working on a computer.
• Ability to operate standard office equipment (e.g., computer, keyboard, phone, printer).
• Visual acuity to read and analyze data on screens and in reports.
• Manual dexterity sufficient to type, use a mouse, and handle office tools.
• Ability to participate in virtual meetings with audio and visual components (e.g., Zoom or Teams).