Compliance Director, AI RCM
ModMed•Boca Raton, FL
•Hybrid
About The Position
The AI RCM Compliance Director acts as a senior individual contributor embedding regulatory logic directly into the RCM AI Platform lifecycle. This role shifts compliance "left" by converting abstract billing regulations into programmatic architectural requirements. As the primary technical gatekeeper, you will engineer the guardrails and metadata frameworks necessary to ensure all AI-generated outputs are accurate, auditable, and legally defensible.
Requirements
- Bachelor’s Degree in a related field.
- 10+ years in RCM, healthcare coding, compliance, or billing.
- Must have active, hands-on experience working in billing and healthcare operations, not just theoretical certifications.
- Deep understanding of RCM workflows, payer rules, and compliance risk management.
- Proven experience implementing compliance programs within high-tech, SaaS, or AI-driven environments.
- Ability to convert "vague" compliance guidelines into technical policies that can be programmatically applied to AI models.
- Ability to be a firm gatekeeper for compliance while remaining a productive partner to technical Product teams.
- Ability to translate complex regulatory requirements into practical guidelines for senior leaders and engineers.
Nice To Haves
- Master’s degree strongly preferred.
Responsibilities
- Review technical requirements to ensure the AI Platform is built according to current coding and billing regulations.
- Determine appropriate and compliant data for use in modeling, ensuring patient privacy and billing integrity are maintained throughout development.
- Review and approve recommendations made by AI assistants or agents; define necessary caveats and guardrails for AI-generated outputs to meet legal standards.
- Continuously assess the RCM regulatory landscape—including payer requirements and coding updates—to identify risks specific to automated workflows.
- Act as a collaborative "defensive" expert between Legal, Compliance, and RCM Operations to align on the organization’s AI risk tolerance.
- Maintain documented compliance controls for AI workflows and partner with internal audit to ensure the platform remains transparent and auditable.
Benefits
- Comprehensive medical, dental, and vision benefits, including a company Health Savings Account contribution
- 401(k): ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep.
- Generous Paid Time Off and Paid Parental Leave programs
- Company paid Life and Disability benefits
- Flexible Spending Account
- Employee Assistance Programs
- Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed
- Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning
- Global presence and in-person collaboration opportunities
- Dog-friendly HQ (US)
- Hybrid office-based roles and remote availability for some roles
- Weekly catered breakfast and lunch
- Treadmill workstations
- Zen, and wellness rooms within our BRIC headquarters.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
