Responsibilities

The Compliance Advisor supports the development, implementation, and ongoing administration of HarmonyCares’ compliance program. This role serves as a compliance resource for healthcare operations, helping to identify, assess, and mitigate compliance risks while promoting adherence to applicable state and federal laws, regulations, and organizational policies. This position supports compliance investigations, regulatory monitoring, governance activities, material reviews, and compliance program initiatives under the direction of the Compliance Director and Chief Compliance Officer.

 

Essential Duties and 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

Qualifications

Required Knowledge, Skills, and Experience

• 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

Preferred Knowledge, Skills and Experience

• Advanced degree in healthcare administration, Business, Public Health, Legal Studies, Paralegal Studies, or a related field
• Prior experience in health plan, managed care, Medicare Advantage, Medicaid, or healthcare provider compliance
• Paralegal experience with a focus on healthcare regulation or healthcare law

Posted Max Pay RateUSD $130,000.00/Yr. Posted Min Pay RateUSD $80,000.00/Yr. Pay TransparencyIndividual compensation packages are based on various factors unique to each candidate, including skill set, experience, qualifications, and other job-related considerations.