Compliance

• 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

Explore Head of Compliance – Part-Time at Mira Mace. Review requirements and application details.

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