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Job Description Summary:

The Compliance Advisor, provides direction and oversight with respect to the compliance activities for OhioHealthy Medical Plan.  The Compliance Advisor is responsible for:

  • Identifying and assessing areas of compliance risk and participating in the annual Ethics & Compliance Program Risk Assessment.
  • Collaborating with stakeholders to effectively incorporate the OhioHealthy Medical Plan compliance needs within the system operations and programs
  • Monitoring compliance with payer (Commercial, Medicaid, Medicare, Medicare Advantage) contracts, and regulatory requirements
  • Working with stakeholders to design and implement  processes for stakeholders to track & audit services provided to OhioHealthy Medical Plan.
  • Auditing OhioHealthy Medical Plan compliance with Clinical Integration requirements
  • Working with stakeholders to develop bylaws, policies and procedures around network management and processes to store confidential data (ie. Provider Scorecard info, Provider Information- Agreements, etc)
  • Developing and implementing compliance education for OhioHealthy Medical Plan as appropriate
  • Managing incident response and open lines of communication for OhioHealthy Medical Plan as appropriate including the ACO’s anonymous reporting mechanism
  • Other compliance duties as assigned

Minimum Qualifications:

Requires a BA/BS; at least 6+ years of health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background. Health plan compliance experience is required


Experience with federal and/or state regulations and compliance oversight in health care. The ability to comprehend and interpret regulatory, legislative, and contractual mandates. Experience with Medicare Advantage


MS/MBA/JD or professional designation preferred.