Compliance - Compliance & Risk Management Specialist 126-2007

Community Care•Tulsa, OK

About The Position

The Compliance & Risk Management Specialist supports the organization’s Compliance and Enterprise Risk Management (ERM) programs under the direction of the Compliance Manager and in collaboration with the Compliance and Risk Officer. The Specialist will work closely and communicate effectively with all operational areas of the company. This position ensures the organization’s adherence to federal and state regulatory requirements across all lines of business. The Specialist serves as a key resource for compliance interpretation, risk analysis, reporting, and program implementation, advancing a culture of regulatory accountability and proactive risk awareness.

Requirements

In-depth knowledge of healthcare compliance and risk management within managed care and government programs (Medicare Advantage, ACA, and commercial products).
Ability to interpret and apply complex regulations, develop monitoring processes, and communicate effectively across levels.
Ability to maintain the highest levels of confidentiality, tact, discretion, and be able to communicate effectively within all levels within the organization, including executive leadership.
Strong analytical, organizational, and problem-solving skills with ability to work independently with minimal supervision and manage multiple priorities.
Excellent written and verbal communication skills, professionalism, and sound judgment.
Proficiency in Microsoft Office (Word, Excel, PowerPoint, SharePoint, Teams); familiarity with CMS systems (e.g., HPMS) desirable.
Successful completion of Health Care Sanctions background check.
Bachelor’s degree in Business, Health Care Administration, or related field required.
Minimum of 5 years of experience in healthcare compliance, regulatory affairs, or enterprise risk management.

Nice To Haves

Experience working with Medicare Advantage and ACA compliance preferred.
Health Care Compliance Association (HCCA) certification (CHC) and/or risk management strongly preferred.

Responsibilities

Stays abreast of current federal and state laws, rules and regulations regarding health plans, particularly Medicare Advantage and Affordable Care (ACA) regulations.
Serve as a resource for compliance questions, regulatory research, and policy interpretation across business areas.
Support design, implementation, and monitoring of the Compliance Program, ensuring alignment with federal and state requirements.
Coordinate assigned compliance initiatives, including regulatory reporting, audit readiness, and annual program updates.
Maintain awareness of regulatory changes and communicate updates, deadlines, and expectations organization wide.
Assist with policy and procedure development, committee documentation, and follow-up actions.
Support preparation of required attestations, submissions, and responses to regulatory inquiries or audits.
Partner with the Compliance and Risk Officer to maintain and execute the organization’s ERM framework.
Facilitate risk identification, assessment, mitigation, and monitoring in collaboration with business owners.
Perform quantitative and qualitative analysis on individual risks and the risk inventory to identify underlying relationships and assist in the risk roll-up/alignment process.
Perform regular monitoring of emerging and upward trending risks, analyze risk trends, and work with risk owners to analyze complex risks and make potential risk mitigation recommendations.
Analyze and report on key risks, controls, and trends to inform leadership and strategic decision-making.
Promote consistent integration of compliance and risk management practices throughout the organization and oversee training on enterprise risk management.
Maintain ERM documentation, policies, procedures, and reporting templates, ensuring they remain current and reflect regulatory expectations and industry best practices.
Oversee and complete key projects, initiatives and daily operational tasks pertaining to the company’s compliance and ERM programs.
Build and maintain effective relationships across departments to embed compliance and risk principles into daily operations.
Contribute to training, communication, and continuous improvement efforts that strengthen compliance culture.
Perform other job-related duties as assigned.