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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive expertise in healthcare compliance, particularly in Medicare Part B billing and coding, while effectively managing regulatory frameworks such as HIPAA and the Anti-Kickback Statute. Capable of developing and implementing compliance programs and providing actionable guidance in a fast-paced startup environment.
Highest-signal resume keywords
Healthcare ComplianceMedicare Part B BillingHIPAA KnowledgeRevenue Cycle OperationsCompliance Program Development
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medicare CodingRegulatory AuditingRisk AssessmentPolicy DevelopmentClaims ManagementDenial ManagementCost-Sharing CollectionCompliance GuidanceFraud PreventionClinical Decision Boundaries
Soft Skills
Clear CommunicationTeam LeadershipAdaptabilityCollaboration
Tools & Technologies
Compliance SoftwareHealthcare Management Systems
Certifications & Qualifications
CHCCHPCCPCCPCO
Industry Keywords
PC-MSOAnti-Kickback StatuteStark LawFalse Claims ActOIG Compliance GuidanceMedicaid Managed CareTelehealth ServicesCare Management
About the role
Key responsibilities & impact- Own Mira Mace's regulatory posture as it scales
- Keep the PC-MSO arrangement compliant, including management services agreements, corporate practice of medicine rules, fair-market-value fees, and clinical/business decision boundaries
- Own the HIPAA privacy and security program, including policies, risk assessments, vendor BAAs, workforce training, access reviews, and breach response
- Audit Medicare coding for care management, E&M, and related services against documentation and time requirements
- Review revenue cycle practices end to end, including eligibility, claim submission, denials and appeals, copay and coinsurance collection, cost-sharing waivers, and overpayment refunds
- Track regulatory developments including the Physician Fee Schedule, NCCI edits, MAC guidance, OIG Work Plan and enforcement actions, and Medicaid and commercial payer policy
- Advise on changes in plain language
- Address fraud, waste, and abuse risks involving the Anti-Kickback Statute, Stark, False Claims Act, and beneficiary-inducement rules
- Build and run a compliance program based on the OIG's General Compliance Program Guidance, including policies, training, monitoring, audits, a hotline, and leadership reporting
- Set policies, review work, train the team, and respond to rule changes and payer inquiries
- Work alongside engineers to embed compliance into software
Requirements
What you’ll need- 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
- Practical ability to give clear, actionable compliance guidance
- Comfort working in a fast-moving startup
- Ability to work alongside engineers to build compliance into software
- Certification such as CHC, CHPC, CPC or CPCO preferred
- Experience with care management (CCM, PCM, APCM, BHI), remote monitoring, or telehealth services preferred
- Experience with Medicare Advantage and Medicaid managed care plans across multiple states preferred
- JD, or experience working closely with healthcare counsel preferred
Benefits
Comp & perks- Part-time (fractional) role with flexible hours