Head of Compliance – Part-Time

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

📋 Description

• Take charge of Mira Mace's regulatory framework as it grows.

• Ensure compliance with the PC-MSO arrangement, encompassing management services agreements, corporate practice of medicine regulations, fair-market-value fees, and delineation of clinical/business decision boundaries.

• Manage the HIPAA privacy and security program, which includes policies, risk assessments, vendor Business Associate Agreements (BAAs), workforce training, access evaluations, and breach response protocols.

• Conduct audits of Medicare coding related to care management, Evaluation & Management (E&M), and associated services to ensure adherence to documentation and time stipulations.

• Analyze revenue cycle processes comprehensively, from eligibility verification and claim submissions to handling denials and appeals, copay and coinsurance collections, cost-sharing waivers, and processing overpayment refunds.

• Monitor regulatory changes including the Physician Fee Schedule, NCCI edits, MAC guidance, OIG Work Plan and enforcement actions, as well as policies from Medicaid and commercial payers.

• Provide advisory services on regulatory changes in layman's terms.

• Tackle risks associated with fraud, waste, and abuse, focusing on the Anti-Kickback Statute, Stark law, the False Claims Act, and beneficiary-inducement regulations.

• Develop and implement a compliance program in line with the OIG's General Compliance Program Guidance, which includes establishing policies, training, monitoring, audits, a hotline, and reporting to leadership.

• Formulate policies, oversee work, train the team, and respond to changes in regulations and payer inquiries.

• Collaborate with engineers to incorporate compliance measures into software solutions.

⛳️ Requirements

• Minimum of 7 years of experience in healthcare compliance, with a focus on Medicare Part B billing and coding.

• Practical experience with a PC-MSO or a comparable physician-practice management structure.

• Comprehensive knowledge of HIPAA regulations, the Anti-Kickback Statute, Stark law, and the False Claims Act.

• Experience in revenue cycle operations, including claims processing, handling denials and appeals, managing patient cost-sharing, and executing overpayment refunds.

• Proven ability to provide clear, actionable compliance advice.

• Comfortable operating in a dynamic startup environment.

• Capable of working alongside engineers to integrate compliance within software development.

• Professional certifications such as CHC, CHPC, CPC, or CPCO are preferred.

• Experience in care management (CCM, PCM, APCM, BHI), remote monitoring, or telehealth services is a plus.

• Familiarity with Medicare Advantage and Medicaid managed care plans across various states is advantageous.

• A Juris Doctor (JD) degree or experience collaborating closely with healthcare legal counsel is preferred.

🏝️ Benefits

• Part-time (fractional) position with flexible hours.