We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more – in our careers and in our communities.

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

SPECIALIZED KNOWLEDGE

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

DESIRED ATTRIBUTES

MS/MBA/JD or professional designation preferred.

APPLY HERE