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Years of Experience
Date Last Verified
ProfileCompliance Risk Advisor The candidate will provide guidance and help enhance and oversee the compliance program related to Medicare risk adjustment to minimize compliance risk exposure to the company. Will work closely with market and/or operations leadership to provide risk assessment of the current and proposed business activities related to Medicare risk adjustment. Oversee enterprise efforts to strengthen compliance controls to minimize fraud, waste, and abuse. Lead and participate in market and corporate team meetings and committees, providing compliance guidance and direction. Serve as subject matter expert on state and federal regulations and to market, corporate, healthcare delivery, managed service organization associates including presentations on changes and updates in laws and regulations. Review business processes to ensure compliance with laws and regulations and enterprise policies and procedures. Receive, investigate and respond to internal compliance issues and local, state and federal regulatory grievances, complaints and inquiries. Oversee activities related to regulatory audits.
Qualification and Experience
The candidate should have Bachelor’s Degree. Must have Juris Doctor from accredited law school. Must have prior experience and knowledge about Medicare Advantage and risk adjustment. Must have prior background working in a compliance related area. Knowledge of the healthcare insurance industry is required. Prior work experience with project management is required. Experience interacting with governmental agencies is required. Strong written and verbal communication skills is required. Strong PC skills including web enabled technologies such as internet based applications; Microsoft Word, Excel, PowerPoint is required. Previous compliance or audit experience is required.