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.

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).

Chief Compliance Officer

Key skills