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Remote, Oregon, United States
Remote only
Location: Remote (U.S.-based)
Commitment: Part-time (fractional), flexible hours
Mira Mace is a venture-backed company on a mission to help Medicare patients navigate a complicated healthcare system with clarity and confidence. We pair people-centered navigation with technology so patients understand their care, stay connected to their providers, and get to the resources they need. Our clinicians and care advocates deliver care management and medical visits to patients across many states, billed to Medicare, Medicare Advantage, Medicaid and commercial plans. Our team has built products and care at places like Google, Meta and Amazon, and at health companies like Landmark Health and Parsley Health.
We're looking for a part-time Head of Compliance to own our regulatory posture as we scale. We operate as a professional corporation / management services organization (PC-MSO), deliver care by phone and video, and bill payers every month for care management and visits. You'll make sure everything we do — how we're structured, how we document, how we code, how we bill and collect — holds up to CMS, OIG, state and payer scrutiny.
This is a hands-on, senior role. You'll set the policies, review the work, train the team, and be the person we call when a rule changes or a payer asks hard questions.
PC-MSO structure: keep our PC-MSO arrangement compliant — management services agreements, corporate practice of medicine rules state by state, fair-market-value fees, and the line between clinical and business decisions.
HIPAA: own our privacy and security program — policies, risk assessments, BAAs with vendors, workforce training, access reviews, and breach response.
Coding and billing: audit our use of Medicare codes (care management, E&M and related services) against documentation and time requirements; catch problems before a claim goes out.
Revenue cycle: review our RCM practices end to end — eligibility, claim submission, denials and appeals, copays and coinsurance collection, cost-sharing waivers, and refunds of overpayments.
Regulatory watch: track the annual Physician Fee Schedule, NCCI edits, MACs' local guidance, the OIG Work Plan and enforcement actions, and Medicaid and commercial payer policy — and tell us what changes for us, in plain words.
Fraud, waste and abuse: keep us clear of the Anti-Kickback Statute, Stark, the False Claims Act and beneficiary-inducement rules, especially in how we reach and enroll patients and work with referral partners.
Program: build and run a compliance program on the OIG's General Compliance Program Guidance — policies, training, monitoring, audits, a hotline, and reporting to leadership.
You know Medicare, Medicaid and commercial rules cold, and you stay current — you read the Fee Schedule final rule when it drops.
You understand how Medicare codes evolve over time: why codes are created, revalued, bundled or retired, and where CMS and the OIG are focusing their scrutiny right now (care management, remote monitoring, telehealth, E&M levels).
You're practical. You give clear answers a team can act on, not a list of every possible risk.
You're comfortable in a fast-moving startup and with working alongside engineers to build compliance into our software.
Required
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.
Preferred
Certification such as CHC, CHPC, CPC or CPCO.
Experience with care management (CCM, PCM, APCM, BHI), remote monitoring, or telehealth services.
Experience with Medicare Advantage and Medicaid managed care plans across multiple states.
JD, or experience working closely with healthcare counsel.
