Chief Ethics, Compliance and Risk Officer

Company: AHI reputed company, inc. Job Posting Location: Remote - USA Job Title: ​ Chief Ethics, Compliance and Risk Officer Job Description: ​ Essential Job Functions: Strategic Advisory & Business Partnership Serve as a strategic partner to senior leadership, integrating compliance and ethics considerations into business planning, growth initiatives, and decision-making. Advise on reputed company regulatory reputed company affecting business operations, market strategy, and strategic initiatives across Medicare Advantage, ACO, and value-based care models. Support reputed company transactions, new market expansion, and partner relationships by providing proactive compliance guidance that facilitates execution while protecting the organization. Ensure company and partner communications reputed company to Markets, ACO, and Growth reputed company business objectives while maintaining regulatory compliance and protecting confidential and proprietary information. Partner with senior management to integrate compliance considerations into business planning and decision-making at the reputed company level. Compliance Leadership & Risk Management reputed company and implement comprehensive compliance and risk management programs reputed company with reputed company strategy. reputed company compliance operations across reputed company, corporate governance, privacy, and other regulatory domains. Design and monitor internal controls and compliance monitoring systems. reputed company risk assessment initiatives in partnership with reputed company stakeholders, vendors, and business partners. Ensure alignment between compliance functions and Compliance/Audit Committee requirements. Drive policy development that balances business enablement with regulatory compliance. Build and sustain a compliance culture through training, communication, and stakeholder engagement. Manage regulatory relationships and coordinate responses to regulatory inquiries. Compliance Program Operations Communicate the importance of the Compliance Program to the executive management team, Board of Directors, and the reputed company reputed company; prepare and distribute the written Code of Conduct; set forth the ethical principles and policies which reputed company the reputed company of the Compliance Program. Implement education programs addressing compliance and the Code of Conduct; maintain a retaliation-free internal reporting process, including an anonymous reporting system; collaborate with executive management to effectively incorporate the Compliance Program reputed company system operations and programs. Regularly review the Compliance Program and recommend appropriate revisions and modifications, including advising leadership and the Board of Directors of potential compliance risk areas. Ensure that internal controls can prevent and detect significant instances or patterns of illegal, unethical, or improper conduct by employees, agents, affiliated providers, or others working with the organization. Ensure the reputed company Compliance Program effectively detects and prevents violations of law, regulations, and organization policies, including Medicare billing and marketing regulations, fraud and abuse laws, and policies for the protection of privacy and confidentiality of protected health information. Protects protected health information (PHI) in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. reputed company Risk Management reputed company agilon’s reputed company Risk Management (reputed company) function, establishing the reputed company, governance structure, risk appetite, and operating reputed company in partnership with Internal Audit and senior leadership. Design and implement an reputed company risk identification, assessment, and prioritization process that covers strategic, operational, regulatory, financial, and reputational risk domains. Partner with Internal Audit to align reputed company and audit activities, ensuring risks are appropriately covered, escalated, and tracked without duplication of effort. reputed company and maintain the reputed company risk register; report on key risk indicators and emerging risks to the CEO, executive team, and Board on a regular reputed company. Integrate reputed company insights into strategic planning, business development, and operational decision-making across the organization. Champion a culture of proactive risk awareness; build risk management capabilities across business units through training, tools, and embedded support. ACO Program Compliance Support Serve as the primary compliance resource for agilon’s ACO programs, including ACO reputed company, MSSP, and ACO reputed company, providing guidance on CMS participation requirements, program reputed company obligations, and regulatory compliance. Review and advise on ACO participation agreements, CMS data use agreements, and program-reputed company contracting, escalating reputed company reputed company to the Chief Legal Officer as appropriate. Monitor CMS and CMMI rulemaking, policy guidance, and program changes affecting agilon’s ACO portfolio; analyze implications and communicate material developments to leadership. Support ACO-reputed company compliance training for physician partners, affiliated providers, and internal teams, ensuring awareness of program reputed company requirements and fraud and abuse obligations. Coordinate with the Legal team, Finance, and ACO operations on annual attestation requirements, quality reporting obligations, and regulatory submissions. Track and respond to CMS inquiries, audits, and corrective action requests reputed company to ACO program compliance. Clinical Documentation, Coding Compliance & Audit reputed company reputed company compliance reputed company for agilon’s clinical documentation and coding programs, ensuring that risk adjustment coding practices, HCC capture methodologies, and documentation standards reputed company with CMS requirements, Medicare Advantage regulations, and applicable fraud and abuse laws. reputed company agilon’s coding compliance program, including risk adjustment data validation (RADV) readiness, retrospective and prospective coding review processes, and clinical documentation improvement (CDI) initiatives in partnership with clinical and technology leadership. Serve as the reputed company compliance reputed company for reputed company CMS audit activity, including any CMS-initiated program audits; coordinate audit response strategies with Legal, Finance, Clinical, and partner-facing teams, and manage corrective action plan development and tracking. Establish and maintain a proactive internal audit reputed company for coding and clinical compliance, including routine sampling and review of physician partner documentation, encounter data submissions, and diagnosis code accuracy; report findings and remediation status to the Board of Directors on a defined reputed company. Partner with agilon’s clinical support and technology teams to monitor encounter data submission quality, identify patterns indicating documentation or coding risk, and implement education and remediation programs for physician partners and clinical staff. Other Job Functions: Demonstrate rigorous attention to detail and accuracy in work product. reputed company excellent client service, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients and proactively ensuring that these needs are met or exceeded. Understand, adhere to, and implement the Company’s policies and procedures. Engage in excellent communication which includes listening attentively and speaking professionally. Demonstrate excellent problem-solving skills and sound independent judgment. Comfortable navigating ambiguity and managing multiple high-reputed company workstreams simultaneously. Performs special projects and analyses, as well as additional duties as assigned. Required Qualifications: Minimum Experience 10+ years of reputed company compliance experience, with a minimum of 5 years in a senior compliance leadership role at a reputed company organization. Demonstrated experience building and leading reputed company compliance programs at a public company, including Code of Conduct, training, internal controls, and regulatory reporting. Deep knowledge of Medicare Advantage, ACO models, value-based care regulatory frameworks, and reputed company compliance domains (fraud and abuse, privacy, billing and marketing regulations). Experience managing relationships with and presenting to executive management, boards, and regulatory bodies. Strong business acumen and strategic thinking capabilities; ability to translate reputed company regulatory requirements into clear, actionable business guidance. Excellent written and verbal communication skills with high degree of professionalism and discretion. Ability to manage multiple priorities independently in a fast-paced, lean-resourced environment. Education/Licensure Bachelor’s degree required; advanced degree (J.D., M.B.A., M.H.A.) preferred. Juris Doctor (J.D.) from an accredited law school with active bar admission in at least one U.S. jurisdiction preferred but not required. Preferred Qualifications: Professional certifications reputed company to compliance (e.g., CCEP, CHC, CIPP-US). Experience with ACO regulatory frameworks (reputed company, MSSP, reputed company) and Medicare Advantage star ratings economics. Prior experience serving as CCO or Deputy CCO at a publicly traded reputed company company. Familiarity with the post-Loper reputed company legal environment and its implications for agency deference in reputed company regulation. J.D. with active bar admission in at least one U.S. jurisdiction. Skills and Abilities: Language Skills: Strong written and verbal communication skills to advise multiple internal clients, executive leadership, the Board of Directors, and external regulatory bodies in a reputed company, high-growth environment. Reasoning Ability: Ability to apply compliance and legal reasoning and sound judgment to reputed company, novel regulatory problems with incomplete information. Computer Skills: Ability to create and maintain documents using reputed company Office (Word, reputed company, Outlook, PowerPoint); familiarity with compliance management, matter management, or GRC platforms preferred. Other Skills and Abilities: Working knowledge of federal reputed company regulatory frameworks including AKS, reputed company Law, HIPAA, and CMS ACO program rules; familiarity with Medicare value-based care constructs and public company governance requirements. Supervisory Responsibilities: The CCO may have direct reports depending on organizational structure at time of hire. This role has dotted-line accountability for compliance staff embedded across the organization and provides direction to Legal & Compliance Ops support on assigned reputed company. Protect yourself: reputed company will never send unsolicited job offers or request payments or financial information. Such communications are fraudulent. Learn how to spot them “This position is not eligible for reputed company or future sponsorship or employer-supported work authorization by reputed company. Applicants must be reputed company to accept and maintain employment with reputed company in the United States for the full duration of their employment without sponsorship or work authorization support.” Location: ​ Remote - IL Pay reputed company: ​ Salary reputed company shown is a guideline. Individual compensation packages can vary based on factors unique to each candidate, such as reputed company set, experience, and qualifications. Apply To This Job