Compliance Advisor

HarmonyCares•,

2d•$80,000 - $130,000

About The Position

HarmonyCares is a leading national value-based provider of in-home primary care services for people with complex healthcare needs. Headquartered out of Troy, Michigan, HarmonyCares operates home-based primary care practices in 14 states. HarmonyCares employs more than 200+ primary care providers to deliver patient-centered care under an integrated, team-based, physician-driven model. Our Mission – To bring personalized, quality-based healthcare to the home of patients who have difficult accessing care. Our Shared Vision – Every patient deserves access to quality healthcare. Our Values – The way we care is our legacy. Every interaction counts. Go the extra mile. Empower and support each other.

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

Nice To Haves

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
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

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