Compliance Advisor
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Job Description
Compliance Advisor at HarmonyCares managing compliance program for healthcare operations. Collaborating with teams to ensure adherence to federal and state regulations and best practices.
Responsibilities:
- Support oversight and compliance activities related to health plan relationships and value-based care arrangements, including Medicare Advantage, Medicaid, ACOs, and other risk-based reimbursement programs, ensuring adherence to applicable contractual, regulatory, and operational requirements
- Assist with identifying, assessing, and mitigating compliance risks across the organization in assigned subject matter areas
- Partner with operational teams to support implementation of regulatory requirements and corrective actions
- Participate in compliance monitoring and oversight activities
- Monitor state and federal regulatory developments impacting health plan relationships and healthcare operations; research and interpret regulatory requirements; and develop and communicate regulatory updates, guidance, summaries, and educational materials to support organizational compliance and stakeholder awareness
- Serve as a resource to business partners on compliance-related matters
- Conduct and support investigations of potential compliance, regulatory, and ethical concerns through document reviews, interviews, research, and other fact-finding activities, and prepare investigation summaries, findings, and recommendations
- Drive root cause analysis and sustainable corrective actions
- Track and monitor corrective action plans related to investigations and audit/monitoring findings
- Support Compliance Committee and Board reporting activities by assisting with the preparation of agendas, presentations, dashboards, meeting materials, minutes, and follow-up documentation to promote effective compliance governance and oversight
- Contribute to periodic compliance reports and compliance program updates to managers, directors, senior and executive leadership
- Review internal, external, member, provider, patient, and marketing communications for compliance and regulatory considerations by collaborating with operational teams to ensure materials align with applicable standards and organizational policies
- Provide feedback and recommendations to business partners regarding regulatory and compliance requirements and collaborate with business partners and compliance team members to support compliance program objectives
- Coordinate assigned compliance projects and workstreams to ensure timely completion of deliverables
- Assist with audits, monitoring activities, risk assessments, writing policies, and special projects
- Employees will be required to perform other job-related assignments as requested
Requirements:
- Bachelor’s degree in healthcare administration, Business, Public Health, Legal Studies, Paralegal Studies, or a related field
- Certified in Healthcare Compliance (CHC) through HCCA or equivalent compliance certification required or the ability to obtain certification within six months of hire
- 3+ years of experience in healthcare compliance, health plan compliance, healthcare regulatory affairs, healthcare legal support, paralegal work, or a related field
- Experience interpreting and applying healthcare laws, regulations, and compliance requirements
- Strong written, verbal, organizational, and analytical skills
- Ability to manage multiple priorities and work independently while collaborating effectively with cross-functional teams
- Proficiency in preparing reports, presentations, and written communications for leadership audiences
- Medicare regulatory experience preferred
- Experience supporting compliance investigations and corrective action activities preferred
- Experience working within both payer and care delivery environments preferred
- Knowledge of compliance program operations, auditing, monitoring, and risk assessment processes preferred
- Prior experience with process and quality improvement preferred
Benefits:
- Health, Dental, Vision, Disability & Life Insurance, and much more
- 401K Retirement Plan (with company match)
- Tuition, Professional License and Certification Reimbursement
- Paid Time Off, Holidays and Volunteer Time
- Paid Orientation and Training
- Great Place to Work Certified
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