Chief Compliance Officer

This is a fully remote position, open to applicants in United States.

📋 Description

• Take charge of compliance for all remote care programs (RPM, CCM, PCM, CoCM, BHI), monitoring CMS rulemaking (Physician Fee Schedule) to integrate compliance directly into operational workflows instead of adding it afterward.

• Manage the clinical licensure framework across multiple states.

• Oversee the entire payor audit process (MAC, RAC, UPIC, TPE, and commercial/MA plan audits).

• Defend against recoupments, handle the Medicare appeals process, safeguard earned revenue, and monitor exposure as a key financial indicator.

• Manage formal payor compliance intakes and medical device evaluations (e.g., Optum/UHG-style submissions) that influence major enterprise partnerships.

• Ensure regulatory compliance for patient outreach processes in accordance with TCPA.

• Continuously enhance the corporate compliance program based on the OIG seven-element standard.

• Lead internal proactive claim sampling and documentation quality assurance with a strict operational rhythm.

• Serve as the compliance representative in enterprise sales, client due diligence, and payor negotiations.

• Provide decision-ready compliance analyses (quantified exposure, framed options, and made recommendations) to the executive team.

• Collaborate closely with the CISO on HIPAA privacy strategies.

⛳️ Requirements

• Proven Payor-Side Fluency: Established experience working within a payor (MA plan, commercial, or a MAC/program-integrity contractor) or extensive history of successfully defending providers against them.

• Quantifiable Recoupment Defense: A proven track record of leading recoupment defense and Medicare appeals, with the ability to articulate specific dollars at risk, dollars safeguarded, and structural wins/losses.

• Battle-Tested Audit Leadership: Experience guiding an organization through rigorous CMS or payor audits (TPE, RAC, UPIC, etc.) as the primary accountable leader.

• Care-Management Billing Depth: Comprehensive understanding of CPT-level requirements for remote care or related programs (time thresholds, supervision rules, device requirements, documentation substantiation).

• Built or Matured a Program: Demonstrated experience in establishing a compliance function from the ground up or improving it from a low baseline in accordance with the OIG seven elements.

• Multi-State Telehealth Competence: Proven experience in managing compliance across a multi-state clinical workforce, including licensure and variations in state-level billing.

• Agile Operational Style: Demonstrated capability to operate effectively in rapidly changing high-growth environments where regulatory and business priorities shift quickly.

• Demonstrated AI Practice: Active use of LLMs and generative AI in your compliance workflows today (e.g., document review, audit preparation, regulatory monitoring).

🏝️ Benefits

• Unlimited PTO

• Medical, Dental, Vision, and supplemental insurance options

• 401(k) Plan with 3.5% Company Match

• Company-provided equipment