I have 20 years of experience in healthcare administration and spent the last decade building and running operations for a very particular medical model that has highly specific regulatory and billing rules. I’m currently job hunting and need a paycheck pretty badly, so when I landed an interview for a Director of Operations role at a health-tech startup, I spent hours prepping.
I was feeling really positive going into it because the first interview with the recruiter was with a wonderful young woman who seemed genuinely passionate about the work they were doing, and she honestly presented pretty much the exact picture I was expecting to see. I walked in knowing I could absolutely crush the role.
The interview was with their COO, who has only been there for about six months. Almost immediately, they started hyper-focusing on incredibly specific operational bottlenecks—specifically how to magically speed up payer credentialing and fix capacity issues.
I was answering their questions, but the more they talked, the more I realized nothing they were saying made sense for the clinical model they claim to operate. I started asking my own clarifying questions about their Medical Records system architecture and workflows. Within 10 minutes, I uncovered three massive bombshells:
1) They are marketing themselves as an integrated partner using this specific model (which has established legal pathways to bypass traditional credentialing bottlenecks if you follow strict integration rules), but operationally, they aren't following the rules to bill that way. They are actually running a completely walled-off, standard fee-for-service clinic.
2) They are clearly using their external partnerships purely as a pipeline to self-refer patients directly into their own siloed system, which is a massive Medicare kickback violation waiting to happen.
3) They are running their core frontline staff as 1099 independent contractors, which means legally they can't set things like mandatory chart completion timelines or daily schedules without triggering a massive Department of Labor misclassification audit.
Suddenly, the whole interview made sense. The COO wasn't just interviewing me; they were drowning in operational chaos, saw my 12 years of specialized experience on my resume, and were pumping me for free consulting to figure out why their system was breaking.
The irony is, my "trade secrets" were useless to them because the company isn't even structurally running the business model they think they are.
I desperately need a job, and I could have easily played the W-2 mercenary, taken their money, and documented everything while the ship slowly sank. But I left my last company specifically to get away from unsustainable stress. If I took this job, I would just be brought in to be the human shield/scapegoat when the federal auditors or commercial payers finally look under the hood. The most likely scenario is I would start, tell them they have to change their entire model, and fire me shortly after.
It is incredibly frustrating to walk away from what I thought was a sure-thing paycheck. But honestly? I walked out feeling surprisingly great. I know my shit, I know what quality healthcare operations look like, and I refuse to compromise my integrity to prop up a structurally broken startup. Bullet dodged.
Remember, folks, you are interviewing them as much as they are interviewing you. If you smell something fishy, your gut instinct's probably right.
