Director of Value Based Care Regulatory Compliance
New
A
agilon health, inc.Healthcare compliance
Remote - USAFull-TimeDirector
Salary153,000 - 191,300 USD per year
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Job Details
- Experience
- 7+ years healthcare compliance experience; 5+ years compliance auditing and monitoring experience; 5+ years supervisory experience.
- Required Skills
- Microsoft Office
Requirements
- Bachelor’s degree in healthcare, business, or a related field.
- 7+ years of healthcare compliance experience, with significant focus on risk adjustment, regulatory affairs, or managed care compliance.
- 5+ years of compliance auditing and monitoring experience, including audit program management and team oversight.
- 5+ years of supervisory experience managing compliance professionals.
- Substantial experience with CMS program requirements across Medicare Advantage risk adjustment and ACO programs.
- Deep knowledge of OIG compliance requirements for MCOs, FDRs, and ACO participants, including audit expectations and high-risk condition monitoring.
- Expertise in risk adjustment coding, RADV audit processes, and supplemental data validation.
- Skilled in regulatory change management, including monitoring, analyzing, and communicating CMS and OIG guidance.
- Knowledge of value-based care, Medicare Advantage, fraud and abuse laws, and ACO REACH and MSSP programs.
- Ability to prepare and deliver compliance metrics and reports for boards and senior leadership.
- Ability to use Microsoft Office, including Word, Excel, Outlook, and PowerPoint.
- Master’s degree preferred; CHC preferred, with CPC or an equivalent risk adjustment coding credential a plus.
Responsibilities
- Lead markets compliance for Medicare Advantage and ACO programs, including ACO LEAD, ACO REACH, and MSSP.
- Develop and implement policies, procedures, and training for markets compliance operations.
- Serve as the compliance liaison to physician partner groups, medical directors, and market leadership.
- Coordinate with health plans and downstream partners on compliance requirements, audits, and corrective actions.
- Oversee risk adjustment compliance, including PMRR and BOI programs, coding audit protocols, and OIG high-risk condition monitoring.
- Partner with Clinical, Legal, and Compliance teams to support compliant clinical pathways and assess vendor arrangements.
- Track CMS, OIG, and federal and state regulatory developments affecting managed care, ACO programs, and value-based care.
- Translate regulatory and enforcement developments into actionable compliance guidance.
- Prepare and present compliance metrics, dashboards, and reports for senior leadership and the internal Compliance Committee.
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