Regulatory Audit: Lead an exhaustive "baseline" audit of clinical and business operations to identify and remediate regulatory vulnerabilities.
OIG Alignment: Design and maintain a Corporate Compliance Program rooted in the OIG’s Seven Elements of an Effective Compliance Program.
Strategic Roadmap: Develop and execute a multi-year compliance strategy that anticipates the regulatory hurdles of new service lines and geographic expansion.
Regulatory Oversight & Signatory Authority
Official Signatory: Act as the authorized signatory for all legal compliance documents, including state licensing applications, Medicare/Medicaid enrollments, regulatory filings, and Attestations of Compliance (AoC).
50-State Telehealth Governance: Ensure absolute adherence to varying state laws regarding synchronous/asynchronous care, provider licensure, and "good faith exam" requirements.
Prescribing Compliance: Manage key risks associated with remote prescribing including DEA compliance if necessary.
Privacy & Security: Serve as the final authority on HIPAA/HITRUST compliance, overseeing data integrity across our platform and third-party integrations.
Operational Integration & "Compliance by Design"
SOP Governance: Author and enforce a comprehensive library of Standard Operating Procedures (SOPs) and the Corporate Code of Conduct.
Product Collaboration: Partner with Product and Engineering to embed "Compliance by Design" into the patient platform, ensuring automated safeguards for clinical workflows.
Reporting Infrastructure: Manage the anonymous reporting hotline and lead all formal internal investigations and disclosures.
Monitoring, Auditing & Corporate Reporting
FWA Prevention: Implement a continuous monitoring system for billing and coding to mitigate Fraud, Waste, and Abuse (FWA) risks.
Corporate Governance: Provide quarterly briefings to the leadership on the enterprise risk profile, mitigation progress, and the impact of legislative shifts.
Requirements
10+ years in healthcare compliance, with at least 5 years in a leadership role within a Virtual Care/Telehealth environment.
JD, Master’s in Healthcare Administration (MHA), or equivalent advanced degree preferred.
Certification with CHC (Certified in Healthcare Compliance) or CHPC (Certified in Healthcare Privacy Compliance) ideal.
An expert in compliance in healthcare organizations, including experience in 50-state telehealth regulations, HIPAA, Stark Law, Anti-Kickback Statute (AKS), and the Ryan Haight Act. You are keeping a pulse on the evolution of AI regulations.
An effective communicator who can educate cross-functional teams about compliance requirements and ensure the development of systems and processes to address compliance