RCM AI Compliance Director

Modernizing-Medicine,-Inc.; Boca Raton (FL); Hybrid; USD 180,000 - 240,000; Full time

Benefits offered by this job

Health insurance

401(k) matching

Paid time off

Tuition reimbursement

Wellness program

Job summary

ModMed, headquartered in Boca Raton, FL, seeks an AI RCM Compliance Director to embed billing regulations into the AI platform lifecycle. The role drives the guardrails, governance, and auditable outputs for compliant AI systems.

The ideal candidate has 10+ years in RCM, healthcare coding, and compliance, with hands-on billing operations experience and the ability to translate complex regulations into technical policies.

Qualifications

• Bachelor’s Degree required; Master’s preferred.
• 10+ years in RCM, healthcare coding, compliance, or billing.
• Hands-on experience with billing operations and regulatory programs.
• Ability to translate vague regulatory guidelines into technical policies.

Responsibilities

• Embed regulatory logic into the AI Platform lifecycle.
• Define guardrails and governance for AI outputs to meet legal standards.
• Continuously assess regulatory risk across payer rules and coding updates.
• Collaborate with Legal, Compliance, and RCM Operations for alignment.

Skills

RCM

Healthcare coding

Compliance

Billing operations

AI governance

Education

Bachelor’s Degree

Master’s degree preferred

Tools

Policy automation tools

Job description

Join the Team Modernizing MedicineAt ModMed, we’re not just building software—we’re reimagining the healthcare experience. Founded in 2010 by a practicing physician and a successful tech entrepreneur, we took a radically different approach: we hired doctors and taught them how to code. This "for doctors, by doctors" philosophy has allowed us to create an AI-enabled, specialty-specific cloud platform that places patients at the center of care.A Culture of ExcellenceWhen you join ModMed, you’re joining an award-winning team recognized for innovation and employee satisfaction. From our global headquarters in Boca Raton Florida, and extensive employee base in Hyderabad India, we are a team of 4,500+ passionate problem-solvers on a mission to increase medical practice success and improve patient outcomes:Consistently ranked as a Top Place to Work2025 Globee Business Awards: Gold Globee for “Technology Team of the Year”2025 Black Book Awards: Ranked #1 EHR in 11 SpecialtiesFlorida Venture Forum: Venture-Backed Company of the YearWe are growing fast, thinking big, and we are just getting started.Ready to modernize medicine with us?Job Description Summary:The AI RCM Compliance Director acts as a senior individual contributor embedding regulatory logic directly into the RCM AI Platform lifecycle. This role shifts compliance "left" by converting abstract billing regulations into programmatic architectural requirements. As the primary technical gatekeeper, you will engineer the guardrails and metadata frameworks necessary to ensure all AI-generated outputs are accurate, auditable, and legally defensible.What you'll doAI Architecture Compliance: Review technical requirements to ensure the AI Platform is built according to current coding and billing regulations.Data Integrity & Privacy: Determine appropriate and compliant data for use in modeling, ensuring patient privacy and billing integrity are maintained throughout development.Output Governance: Review and approve recommendations made by AI assistants or agents; define necessary caveats and guardrails for AI-generated outputs to meet legal standards.Regulatory Risk Assessment: Continuously assess the RCM regulatory landscape—including payer requirements and coding updates—to identify risks specific to automated workflows.Cross-Functional Alignment: Act as a collaborative "defensive" expert between Legal, Compliance, and RCM Operations to align on the organization’s AI risk tolerance.Audit & Control Maintenance: Maintain documented compliance controls for AI workflows and partner with internal audit to ensure the platform remains transparent and auditable.What you'll bringBachelor’s Degree in a related field.Master’s degree strongly preferred.10+ years in RCM, healthcare coding, compliance, or billing.Must have active, hands-on experience working in billing and healthcare operations, not just theoretical certifications.Deep understanding of RCM workflows, payer rules, and compliance risk management.Proven experience implementing compliance programs within high-tech, SaaS, or AI-driven environments.Ability to convert "vague" compliance guidelines into technical policies that can be programmatically applied to AI models.Ability to be a firm gatekeeper for compliance while remaining a productive partner to technical Product teams.Ability to translate complex regulatory requirements into practical guidelines for senior leaders and engineers.ModMed Benefits Highlight: At ModMed, we believe it’s important to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits:United StatesComprehensive medical, dental, and vision benefits, including a company Health Savings Account contribution,401(k): ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep.Generous Paid Time Off and Paid Parental Leave programs,Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs,Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed,Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning,Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles,Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters.PHISHING SCAM WARNING: ModMed is among several companies recently made aware of a phishing scam involving imposters posing as hiring managers recruiting via email, text and social media. The imposters are creating misleading email accounts, conducting remote "interviews," and making fake job offers in order to collect personal and financial information from unsuspecting individuals. Please be aware that no job offers will be made from ModMed without a formal interview process, and valid communications from our hiring team will come from our employees with a ModMed email address ([e-mail]). Please check senders’ email addresses carefully. Additionally, ModMed will not ask you to purchase equipment or supplies as part of your onboarding process. If you are receiving communications as described above, please report them to the FTC website.