Chief Compliance Officer

Key Responsibilities

• Own compliance for all remote care programs (RPM, CCM, PCM, CoCM, BHI), tracking CMS rulemaking (Physician Fee Schedule) to build compliance directly into operational workflows rather than bolting it on.
• Oversee multi-state clinical licensure infrastructure.
• Lead the end-to-end payor audit lifecycle (MAC, RAC, UPIC, TPE, and commercial/MA plan audits).
• Defend recoupments, manage the Medicare appeals process, protect earned revenue, and track exposure as a core financial metric.
• Own formal payor compliance intakes and medical device assessments (e.g., Optum/UHG-style submissions) that gate major enterprise relationships.
• Maintain regulatory compliance for patient outreach workflows under TCPA.
• Continuously mature the corporate compliance program against the OIG seven-element standard.
• Direct internal proactive claim sampling and documentation QA with a rigid operational cadence.
• Act as the compliance voice in enterprise sales, client diligence, and payor negotiations.
• Deliver decision-ready compliance analysis (exposure quantified, options framed, recommendations made) to the executive team.
• Partner closely with the CISO on HIPAA privacy postures.

Qualifications

• Proven Payor-Side Fluency: Proven experience working inside a payor (MA plan, commercial, or a MAC/program-integrity contractor) or spent years successfully defending providers against them.
• Quantifiable Recoupment Defense: Demonstrated history of personally leading recoupment defense and Medicare appeals, and can walk through specific dollars at risk, dollars protected, and your structural wins/losses.
• Battle-Tested Audit Leadership: Experience taking an organization through intensive CMS or payor audits (TPE, RAC, UPIC, etc.) as the primary responsible leader.
• Care-Management Billing Depth: Working command of CPT-level requirements for remote care or adjacent programs (time thresholds, supervision rules, device requirements, documentation substantiation).
• Built or Matured a Program: Demonstrated experience formalizing a compliance function from scratch or a low baseline against the OIG seven elements.
• Multi-State Telehealth Competence: Proven ownership of compliance across a multi-state clinical workforce, including licensure and state-level billing variations.
• Agile Operational Style: Proven ability to operate cleanly in high-growth environments where regulatory and business roadmaps reprioritize rapidly.
• Demonstrated AI Practice: Active usage of LLMs and generative AI in your compliance workflows today (e.g., document review, audit prep, regulatory monitoring).