10 Steps to Becoming a Healthcare Compliance Consultant
Over the last thirty years, I have been frequently asked the question; “How can I move from being a compliance officer to a compliance consultant.” Having served in a compliance capacity in a structured work environment does not immediately translate into being a compliance consultant. It does provide a foundation that can be used in developing into a consultant advisor. A successful compliance consultant involves developing a combination of technical, analytical, interpersonal, combination of experiences, and regulatory knowledge skills. How these are applied are different from being an employee, but an advisor. The following highlight 10 steps that can prepare someone to become a healthcare compliance consultant:
Step 1. Education. Education is critically important for healthcare compliance professionals because of the complex, high-stakes, and constantly evolving nature of the healthcare industry. Begin with a bachelor’s degree in any number of related fields, such as healthcare administration, public health, nursing, business administration, accounting, and legal. However, to meet the market expectations, it is important to gain a post graduate degree (e.g., Master of Public Health (MPH), Master of Health Administration (MHA), Master of Business Administration (MBA), Law Degree (JD), Certified in Public Accounting (CPA), Nursing (MSN), etc.).
Step 2. Gain Broad Experience. Obtain work in the compliance space by serving as a compliance analyst, billing/coding specialist, risk management associate, privacy officer, internal auditing, compliance investigator, etc. Find ways to be cross trained in different compliance capacities. Having experience in more than one organization helps develop perspective on how different organizations develop and manage their compliance programs. During this foundation period it is important to build expertise with various regulatory areas such as: HIPAA (Privacy & Security Rules), CMS guidelines and Conditions of Participation, False Claims Act, Stark Law / Anti-Kickback Statute, OIG Compliance Program Guidance, DOJ Compliance Program Effectiveness Guidelines, State-specific laws and Medicaid regulations.
Step 3. Develop Compliance Skills. There are several key compliance skills that can later be applied in a consulting role: (1) Familiarity with regulatory bodies such as the Department of Justice (DOJ), Office of Inspector General (OIG), Food and Drug Administration (FDA), Office for Civil Rights (OCR), and Medicaid Fraud Control Units (MFCUs); (2) Analytical thinking to assess risk, identify compliance gaps, and solve problems; (3) Ability to communicate complex regulatory issues in simple, understandable terms; (4) Skill in developing and delivering effective compliance training; (5) Project management capabilities to lead compliance initiatives and manage resources efficiently; (6) Problem-solving and diplomacy for navigating sensitive or complex organizational challenges; (7) Auditing and monitoring skills, including the ability to evaluate and improve internal processes; (8) Strong interpersonal skills for working collaboratively with stakeholders at all levels of an organization; (9) Awareness of industry-specific compliance requirements, especially in fields like healthcare, finance, and energy; (10) Understanding of corporate governance and operational processes, and the ability to align compliance strategies with broader business objectives; (11) Strong writing skills for drafting clear reports, policies, and procedures; and (12) The ability to present findings and recommendations effectively to senior leadership and other key stakeholders.
Step 4. Professional Association/Networking. Joining professional associations and actively participating in their conferences, webinars, and training sessions is an important step in your development. These organizations often offer newsletters, job boards, and opportunities for advanced education. Involvement not only helps you stay up to date with regulatory developments and best practices but also enables you to build valuable professional relationships. Networking through these associations can open doors, provide mentorship, and create a foundation of contacts that may be instrumental as you transition into a consulting role.
Step 5. Professional Certifications. Healthcare compliance professionals pursue certifications to demonstrate their knowledge, credibility, and commitment to regulatory and ethical standards within the industry. For those seeking to become consultants, earning professional certifications is especially important. Key certifications include Certified in Healthcare Compliance (CHC), Certified in Healthcare Privacy Compliance (CHPC), Certified in Healthcare Research Compliance (CHRC), Certified Professional Coder (CPC), and Certified Outpatient Coder (COC), among others. Holding multiple certifications not only broadens your expertise but also enhances your professional profile and credibility in the consulting marketplace.
Step 6. Obtain Contracting Experience. The foundational knowledge and experience developed through years of working in a compliance office are essential, but they do not automatically prepare someone to become a successful consultant. Many professionals assume that having served as a compliance officer means they are ready to “hang out a shingle” as a consultant, however, this transition involves a new learning curve. The old saying “all beginnings are difficult” certainly applies to newly minted consultants. Working internally in a compliance role is quite different from functioning as an external advisor delivering services to diverse organizations. To bridge this gap, it’s crucial to gain hands-on consulting experience by working for an established consulting firm, either as an employee or as a contractor. This provides insight into the consulting business, including managing client relationships, drafting proposals and contracts, delivering services efficiently, and building a client base. It also allows for exposure to different industries and compliance challenges, while offering the opportunity to observe seasoned consultants in action. Just as important is learning how to foster strong, positive relationships with clients, an essential skill for any successful consultant.
Step 7. Contract with a Consulting Firm. For many independent compliance professionals, contracting with an established consulting firm offers a more accessible and stable path into consulting. Such arrangements provide valuable experience and a stream of client work without the burden of marketing your services alone. Under a contractor relationship, the consulting firm typically offers project-based engagements, allowing consultants to focus on service delivery while benefiting from the firm’s infrastructure, client network, and administrative support. This can also offer professional and legal protections under the firm’s umbrella. For decades, firms like Strategic Management have successfully partnered with independent consultants on various projects, creating mutually beneficial relationships and contributing to the professional growth of the consultants involved.
Step 8. Establish Limited Liability Company (LLC). Whether you’re launching your own consulting business or contracting with an established firm, it is highly advisable to register as a Limited Liability Company (LLC). Operating as an LLC helps establish your status as an independent contractor rather than being viewed as a full- or part-time employee. This distinction is especially important under IRS guidelines, which set forth criteria to determine whether a working relationship qualifies as independent contracting. Creating an LLC provides legal separation between personal and business liabilities, adds credibility, and is a clear step toward meeting the standards for contractor status when offering services to clients or firms.
Step 9. Develop a Business Plan. A well-structured business plan is essential when starting a consulting practice. It should begin by defining your core capabilities, such as building compliance programs from the ground up, conducting HIPAA privacy audits, serving as an interim compliance or privacy officer, performing compliance risk assessments, or conducting regulatory analysis. The plan should also outline your business structure (LLC, Corporation), ownership details, and a clear strategy for marketing and promoting your services. Additionally, include your operational approach, required technology and equipment, necessary legal documentation, and a professional website. A polished website enhances your legitimacy and can serve as an important platform to communicate your services and expertise to potential clients.
Step 10. Obtain Tort Liability Insurance. Securing professional liability (tort) insurance with multi-million-dollar coverage is crucial for any independent compliance consultant. This type of insurance not only protects you from claims arising from your services, but also instills confidence in clients who may be concerned about the risks of working with an external advisor. In cases where you are contracting through an established consulting firm, that firm may provide insurance coverage for the projects you are assigned. It’s important to clarify this arrangement in advance. If coverage is not provided by the firm, you should secure your own policy to ensure you’re protected and professionally prepared.
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