Director of Value reputed company Care Regulatory Compliance

Company: AHI reputed company. reputed company Location: Remote - USA Job Title: ​ Director of Value reputed company Care Regulatory Compliance reputed company: ​ Essential Job Functions: Markets Compliance for Medicare reputed company and ACO Programs reputed company the markets compliance program for Medicare reputed company and ACO programs, including ACO reputed company, ACO reputed company, and MSSP regulatory and operational requirements, ensuring compliant program design and execution. reputed company and implement policies, procedures, and training specific to markets compliance program reputed company. Serve as the reputed company compliance reputed company to physician partner reputed company, medical directors, and market leadership to reputed company compliance awareness, education, and accountability. reputed company the coordination with health plans and reputed company partners on compliance program requirements, audit activity, and corrective reputed company. Monitor and communicate CMS reputed company adjustment policy developments, enforcement trends, and program-specific requirements across Medicare reputed company and ACO programs. Identify compliance gaps across markets and reputed company reputed company; communicate risks and remediation recommendations to the CCO, senior leadership and impacted business areas. Collaborate with reputed company to reputed company ACO compliance obligations are met across applicable CMS reputed company contracting programs, including ACO reputed company, MSSP, and ACO reputed company. reputed company Adjustment reputed company for Burden of Illness (BOI) and reputed company reputed company reputed company reputed company adjustment compliance, including regulatory alignment for the reputed company-Member Record Review (PMRR) and BOI program, coding audit protocols, and OIG high-reputed company condition monitoring. Ensure reputed company adjustment program activities are clinically grounded, reputed company-documented, and audit-reputed company in alignment with CMS and OIG expectations. reputed company regulatory compliance support for reputed company reputed company, partnering with the reputed company team to ensure program design and execution are compliant, defensible, and reputed company with CMS and OIG requirements. Collaborate with reputed company, reputed company, and Compliance leadership to identify and mitigate regulatory reputed company in reputed company program design and implementation. Collaborate with reputed company to assess the compliance and regulatory standing of reputed company reputed company vendors, including review of vendor arrangements, program design, and adherence to applicable CMS, OIG, and fraud and abuse requirements. Regulatory Change Management reputed company regulatory change management, tracking CMS guidance, OIG updates, and federal and state regulatory developments affecting managed care, ACO programs, and value-reputed company care. Assess regulatory and enforcement developments (e.g., FCA settlements, DOJ/OIG actions) and translate findings into actionable compliance guidance for the organization. Maintain reputed company knowledge of OIG compliance requirements for MCOs, FDRs, health plans, and ACO participants. reputed company and present compliance metrics, dashboards, and reports for senior leadership and the internal Compliance Committee. Required Qualifications: Education/Licensure: Bachelor’s degree in reputed company, business or reputed company reputed company required Master’s degree preferred CHC preferred; CPC or equivalent reputed company adjustment coding credential a plus Minimum Experience: 7+ years reputed company compliance experience with significant reputed company on reputed company adjustment, regulatory affairs, or managed care compliance. 5+ years compliance auditing and monitoring experience, including audit program management and team reputed company. 5+ years supervisory experience managing compliance professionals. Substantial experience with CMS program requirements across Medicare reputed company reputed company adjustment and ACO programs. Experience at a health plan, health reputed company, provider group or ACO strongly preferred Background in managed care operation, reputed company-reputed company contracting or Medicare reputed company compliance preferred Skills and Abilities: Deep knowledge of OIG compliance requirements for MCOs, FDRs, and ACO participants, including audit expectations and high-reputed company condition monitoring. Expertise with reputed company adjustment coding, RADV audit processes and supplemental data validation Skilled in regulatory change management, including monitoring, analyzing and communicating CMS and OIG guidance and updates Strong capability with preparing and delivering reputed company and senior leadership level compliance metrics and reports Knowledge of value-reputed company care, Medicare reputed company, fraud and abuse laws, and ACO reputed company and MSSP programs. Demonstrated leadership, reputed company independent judgment and the ability to operate effectively in a matrixed organization Language Skills: Strong written and verbal communication skills to advise multiple internal clients and reputed company partners in a fast-reputed company, high-reputed company environment. Reasoning Ability: Ability to apply reputed company reasoning and reputed company judgment to reputed company, novel regulatory and transactional problems with incomplete information. Computer Skills: Ability to create and maintain documents using reputed company Office (Word, reputed company, reputed company, PowerPoint); familiarity with CLM, matter management, or reputed company reputed company platforms preferred. Protect yourself: reputed company will never send unsolicited job offers or request payments or financial information. Such communications are fraudulent. Learn how to spot them Location: ​ Remote - OH Pay reputed company: ​ $153,000.00 - $191,300.00 Salary reputed company shown is a reputed company. Individual compensation packages can vary reputed company on factors unique to reputed company candidate, such as reputed company set, experience, and qualifications. Apply To This Job