Value-Based Care Compliance Director — Remote

Agilon Health, Inc.; Kentucky; Hybrid; USD 115,000 - 191,000; Full time

Job summary

AHI agilon health, inc. is seeking a Director of Value Based Care Regulatory Compliance to lead markets compliance for Medicare Advantage and ACO programs, including ACO REACH and MSSP, with a focus on risk adjustment and day-to-day regulatory operations.

You will oversee PMRR/BOI programs, regulatory change management, and collaborate with Clinical, Legal, and Compliance leadership to mitigate risk and ensure audit readiness.

Qualifications

• Bachelor’s degree in healthcare, business or related field required.
• Master’s degree preferred; CHC preferred; CPC or equivalent risk adjustment coding credential a plus.
• 7+ years healthcare compliance experience with focus on risk adjustment, regulatory affairs, or managed care compliance.
• 5+ years compliance auditing and monitoring experience, including audit program management and team oversight.
• 5+ years supervisory experience managing compliance professionals.
• Substantial experience with CMS program requirements across Medicare Advantage risk adjustment and ACO programs.

Responsibilities

• Lead markets compliance for Medicare Advantage and ACO programs, including ACO LEAD, ACO REACH, and MSSP regulatory requirements.
• Oversee risk adjustment compliance, including PMRR and BOI program, coding audit protocols, and OIG monitoring.
• Lead regulatory change management; track CMS guidance, OIG updates, and federal/state developments; provide metrics for leadership.

Skills

OIG compliance

Risk adjustment coding

Regulatory change mgmt

Leadership metrics

Value-based care

ACO programs

Education

Bachelor's degree

Master's degree preferred

CHC preferred

CPC credential

Job description

AHI agilon health, inc. is seeking a Director of Value Based Care Regulatory Compliance to lead markets compliance for Medicare Advantage and ACO programs, including ACO REACH and MSSP, with a focus on risk adjustment and day-to-day regulatory operations.

You will oversee PMRR/BOI programs, regulatory change management, and collaborate with Clinical, Legal, and Compliance leadership to mitigate risk and ensure audit readiness.