Head of Compliance (Part-Time)

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 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.

Responsibilities

Keep the PC-MSO arrangement compliant, including management services agreements, corporate practice of medicine rules state by state, fair-market-value fees, and the line between clinical and business decisions; Own the privacy and security program, including policies, risk assessments, BAAs with vendors, workforce training, access reviews, and breach response; Audit use of Medicare codes (care management, E&M and related services) against documentation and time requirements; Review revenue cycle practices end to end, including eligibility, claim submission, denials and appeals, copays and coinsurance collection, cost-sharing waivers, and refunds of overpayments; Track the annual Physician Fee Schedule, NCCI edits, MACs' local guidance, the OIG Work Plan and enforcement actions, and Medicaid and commercial payer policy; Keep the company clear of the Anti-Kickback Statute, Stark, the False Claims Act and beneficiary-inducement rules; Build and run a compliance program based on the OIG's General Compliance Program Guidance, including policies, training, monitoring, audits, a hotline, and reporting to leadership

Requirements

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

Nice to have

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