Head of Compliance (Part-Time)

Location: Remote (U.S.-based)

Commitment: Part-time (fractional), flexible hours

About the Role

We're looking for a part-time Head of Compliance to own our regulatory posture as we scale. We operate as a professional corporation / management services organization (PC-MSO), deliver care by phone and video, and bill payers every month for care management and visits. You'll make sure everything we do - how we're structured, how we document, how we code, how we bill and collect - holds up to CMS, OIG, state and payer scrutiny.

This is a hands-on, senior role. You'll set the policies, review the work, train the team, and be the person we call when a rule changes or a payer asks hard questions.

What You'll Do

• PC-MSO structure: keep our PC-MSO arrangement compliant - management services agreements, corporate practice of medicine rules state by state, fair-market-value fees, and the line between clinical and business decisions.
• HIPAA: own our privacy and security program - policies, risk assessments, BAAs with vendors, workforce training, access reviews, and breach response.
• Coding and billing: audit our use of Medicare codes (care management, E&M and related services) against documentation and time requirements; catch problems before a claim goes out.
• Revenue cycle: review our RCM practices end to end - eligibility, claim submission, denials and appeals, copays and coinsurance collection, cost-sharing waivers, and refunds of overpayments.
• Regulatory watch: track the annual Physician Fee Schedule, NCCI edits, MACs' local guidance, the OIG Work Plan and enforcement actions, and Medicaid and commercial payer policy - and tell us what changes for us, in plain words.
• Fraud, waste and abuse: keep us clear of the Anti-Kickback Statute, Stark, the False Claims Act and beneficiary-inducement rules, especially in how we reach and enroll patients and work with referral partners.
• Program: build and run a compliance program on the OIG's General Compliance Program Guidance - policies, training, monitoring, audits, a hotline, and reporting to leadership.

Who You Are

• You know Medicare, Medicaid and commercial rules cold, and you stay current - you read the Fee Schedule final rule when it drops.
• You understand how Medicare codes evolve over time: why codes are created, revalued, bundled or retired, and where CMS and the OIG are focusing their scrutiny right now (care management, remote monitoring, telehealth, E&M levels).
• You're practical. You give clear answers a team can act on, not a list of every possible risk.
• You're comfortable in a fast-moving startup and with working alongside engineers to build compliance into our software.

Qualifications

Required

• 7+ years in healthcare compliance, with Medicare Part B billing and coding at the center of it.
• Hands-on experience with a PC-MSO or similar physician-practice management structure.
• Deep working knowledge of HIPAA, the Anti-Kickback Statute, Stark, and the False Claims Act.
• Experience with revenue cycle operations: claims, denials, appeals, patient cost-sharing, and overpayment refunds.

Preferred

• Certification such as CHC, CHPC, CPC or CPCO.
• Experience with care management (CCM, PCM, APCM, BHI), remote monitoring, or telehealth services.
• Experience with Medicare Advantage and Medicaid managed care plans across multiple states.
• JD, or experience working closely with healthcare counsel.