Director, Compliance - ACO & Payor Operations

Job Title: Director, Compliance – ACO & Payor OperationsLocation: Farmers Branch, TX (Hybrid – 3 Days Onsite per Week)Employment Type: Direct HireSalary: $160,000–$180,000Position SummaryThe Director, Corporate Compliance oversees the day-to-day operations of the enterprise compliance program for a large, value-based Accountable Care Organization (ACO).This role functions as an independent and objective leader responsible for ensuring compliance with federal and state healthcare regulations, CMS requirements, managed care and payor contractual obligations, accreditation standards, and internal governance policies.The Director provides strategic oversight and operational leadership to ensure the compliance program effectively identifies, prevents, detects, and corrects noncompliance across a complex, risk-bearing healthcare network. This position plays a critical role in protecting the organization from regulatory, financial, and reputational risk.Key ResponsibilitiesEnterprise Compliance Program Leadership

• Lead and operationalize a comprehensive corporate compliance program aligned with OIG guidance and CMS requirements.*
• Develop, implement, and maintain compliance policies, procedures, and controls specific to ACO and managed care operations.*
• Maintain and update the Compliance Plan and Code of Conduct.*
• Ensure program effectiveness in a value-based, risk-sharing environment.

Managed Care & Regulatory Oversight

• Oversee compliance related to:*
  • CMS ACO programs (e.g., MSSP, ACO REACH)* *
  • Medicare Advantage and commercial payor contracts* *
  • Fraud, Waste & Abuse (FWA) regulations* *
  • Third-Party Administration (TPA) laws* *
  • Prompt pay requirements* *
  • Participating provider agreements* *
  • Credentialing and enrollment regulations*
• Monitor evolving regulatory requirements impacting risk-based and payor-facing operations.

Risk Assessment & Monitoring

• Conduct annual enterprise compliance risk assessments.*
• Develop risk profiles, compliance workplans, KPIs, and corrective action plans.*
• Monitor compliance metrics and financial exposure indicators tied to value-based contracts.*
• Evaluate internal controls and identify regulatory vulnerabilities.

Investigations & Issue Resolution

• Serve as an independent review body for compliance concerns and hotline reports.*
• Lead investigations into alleged noncompliance, fraud, abuse, or unethical conduct.*
• Partner with Legal, Risk Management, HR, Finance, Revenue Cycle, and Credentialing teams.*
• Engage internal and external counsel when appropriate.

Reporting & Governance

• Provide regular reporting to:*
  • Corporate Compliance Committee* *
  • Audit & Compliance Committee* *
  • Board of Trustees* *
  • Senior Executive Leadership*
• Support board-level oversight and ensure transparency of compliance risks.*
• Present findings, risk mitigation strategies, and program performance metrics.

External Audits & Regulatory Coordination

• Oversee preparation and response to:*
  • CMS audits* *
  • Contracted payor audits* *
  • State Departments of Insurance* *
  • Accreditation reviews*
• Ensure timely remediation of audit findings and regulatory deficiencies.

Training & Culture of Compliance

• Develop and maintain enterprise compliance training programs.*
• Partner with HR to deliver onboarding and annual compliance education.*
• Promote Compliance Hotline awareness and retaliation-free reporting culture.*
• Communicate regulatory updates impacting operational teams.

Required QualificationsEducationBachelor’s Degree in Healthcare Administration, Business, or related field.Experience

• Minimum 5 years of progressive management experience in healthcare compliance.*
• Experience within a large healthcare organization (10,000+ employees preferred).*
• Direct experience in:*
  • Managed care or payor compliance* *
  • ACO or value-based care environments* *
  • CMS regulatory oversight* *
  • Enterprise risk management* *
  • Board-level reporting*
• Demonstrated people leadership experience required.

Higher education may substitute for minimum experience:

• Master’s Degree = 2 years equivalent experience*
• JD = 2–3 years equivalent experience

Licensure / CertificationCertified in Healthcare Compliance (CHC) – REQUIREDPreferred Qualifications

• Master’s Degree in Healthcare Compliance or related field.*
• Experience within:*
  • Large health systems* *
  • Managed care organizations* *
  • Medicare Advantage plans* *
  • Corporate compliance departments* *
  • Risk-bearing ACO networks*

Knowledge, Skills & AbilitiesThorough knowledge of:

• Federal and state healthcare regulations*
• CMS rules and ACO program requirements*
• HIPAA and privacy regulations*
• Fraud, Waste & Abuse (FWA) laws*
• Third-Party Administration (TPA) laws*
• Provider agreements and network contracts*
• Credentialing and enrollment regulations*
• Prompt pay laws*
• Accreditation standards*
• Internal controls and regulatory risk mitigation

Additional competencies:

• Enterprise risk management capability*
• Budget oversight experience*
• Strong organizational and strategic planning skills*
• Ability to manage highly confidential information*
• Exceptional written, verbal, and executive-level communication skills