Senior Director, Value-Based Care Compliance

Agilon Health, Inc.; Northern (KY); Ibrido; USD 153.000 - 191.000; Tempo pieno

Descrizione del lavoro

AHI agilon health, inc. is seeking a Director of Value Based Care Regulatory Compliance to lead market compliance for Medicare Advantage and ACO programs from a remote location in the United States.

The role oversees risk adjustment, regulatory change management, and collaboration with Legal, Clinical and Compliance teams to ensure CMS and OIG alignment. The position requires extensive experience in healthcare compliance, risk adjustment and managed care, with leadership responsibilities across

Competenze

• Bachelor’s degree in healthcare, business or related field required.
• Master’s degree preferred; CHC certification a plus.
• 7+ years healthcare compliance experience focused on risk adjustment or managed care.
• Experience auditing and supervising teams; CMS program experience across MA/ACO.

Mansioni

• Lead markets compliance program for MA and ACO programs (ACOs LEAD, REACH, MSSP).
• Develop policies, procedures and training for markets compliance operations.
• Serve as regulatory liaison to physician partner groups, medical directors and market leadership.
• Coordinate with health plans and downstream partners on audits and remediation.
• Monitor CMS risk adjustment policy developments and enforcement trends.
• Identify gaps and communicate risks to the CCO and leadership.
• Collaborate with Legal on CMS obligations for ACO programs.
• Lead regulatory change management and report metrics to senior leadership.

Conoscenze

OIG compliance (MCOs/FDRs/ACOs)

Risk adjustment coding

Regulatory change management

Board‑level reporting

Formazione

Bachelor’s degree in healthcare/business/related field

Master’s degree preferred

CHC preferred

CPC or risk adjustment credential a plus

Strumenti

Microsoft Office (Word/Excel/Outlook/PowerPoint)

CLM

Matter management

Legal operations platforms

Descrizione del lavoro

AHI agilon health, inc. is seeking a Director of Value Based Care Regulatory Compliance to lead market compliance for Medicare Advantage and ACO programs from a remote location in the United States.

The role oversees risk adjustment, regulatory change management, and collaboration with Legal, Clinical and Compliance teams to ensure CMS and OIG alignment. The position requires extensive experience in healthcare compliance, risk adjustment and managed care, with leadership responsibilities across