Head of Compliance (Part-Time)

OpenKrill; United States; À distance; USD 83 000 - 124 000; Temps partiel

Résumé du poste

Mira Mace is seeking a part-time Head of Compliance to own our regulatory posture as we scale. You will set policies, review work, train the team, and respond when rules change or payers ask hard questions.

This senior, hands-on role requires deep Medicare/Medicaid and commercial payer knowledge, building a compliant PC-MSO framework while collaborating with engineers to embed compliance into software.

Qualifications

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

Responsabilités

• Maintain PC-MSO compliance including MSAs and state CPOM rules.
• Own privacy and security program: policies, risk assessments, BAAs, training, access reviews, and breach response.
• Audit Medicare codes (care management, E/M) against docs and timing; fix issues before claims go out.
• Oversee revenue cycle: eligibility, submissions, denials, appeals, copays, refunds.
• Track regulatory changes (FEE schedule, NCCI, MACs, OIG plan) and explain impact plainly.
• Guard against fraud, waste and abuse per AKS, Stark, False Claims Act and beneficiary rules.
• Build and run a compliance program per OIG guidelines: policies, training, monitoring, audits, hotline, leadership reporting.

Connaissances

Medicare Part B billing

HIPAA knowledge

Regulatory compliance

CMS guidance tracking

Risk assessment

Formation

HC certifications (CHC/CHPC/CPC/CPCO)

Juris Doctor (JD)

Description du poste

Location: Remote (U.S.-based)Commitment: Part-time (fractional), flexible hours

ABOUT MIRA MACE

Mira Mace is a venture-backed company on a mission to help Medicare patients navigate a complicated healthcare system with clarity and confidence. We pair people-centered navigation with technology so patients understand their care, stay connected to their providers, and get to the resources they need. Our clinicians and care advocates deliver care management and medical visits to patients across many states, billed to Medicare, Medicare Advantage, Medicaid and commercial plans. Our team has built products and care at places like Google, Meta and Amazon, and at health companies like Landmark Health and Parsley Health.

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.