Director, Government Programs/ACO Compliance Officer

Company Description

Privia Health™ is a national physician platform transforming the healthcare delivery experience. We provide tailored solutions for physicians and providers, creating value and securing their future. Through high-performance physician groups, accountable care organizations, and population health management programs, Privia works in partnership with health plans, health systems, and employers to better align reimbursements to quality and outcomes.

Job Description

Title: Director, Government Programs/ACO Compliance Officer

Employment Type: FTE

Exemption Status: Exempt

Travel Required: <10%

Location: Remote

Overview of the Role:.

Privia Health Group, Inc. (Privia) has an immediate opening for a Director, Government Programs to join our growing team. The Director, Government Program will work with the Senior Director, Compliance and Chief Compliance Officer to ensure all required elements of an effective Compliance Program are met. This position will serve as the ACO Compliance Officer and be responsible for reviewing and developing processes and controls to ensure compliance with Federal laws and regulations applicable to Privia’s Accountable Care Organizations (ACO) and Medicare Advantage operations. The Director, Government Programs will be responsible for providing expert guidance on aspects of policy development, protocols, and industry best practices.

Essential Job Duties:

• Provide compliance oversight and direction related to ACO and Medicare Advantage operations and business development.
• Maintain current knowledge of ACO and and other Government program legal and regulatory requirements and industry standards.
• Assist in creating compliance, Medicare Advantage and ACO policies.
• Collaborate with stakeholders to develop procedures in support of policies and compliance.
• Participate in risk assessment and develop a risk based audit program to ensure compliance.  Work with departmental management to determine formal corrective action plans.
• Performing audits, with assistance of Compliance Specialists, and providing detailed reports of findings.
• Develop and monitor dashboards to oversee compliance risks and activities.
• Maintain processes and procedures for required monitoring and reporting for contract and Government compliance.
• Assist in the coordination and timely response of audits performed by regulatory agencies or payors.
• Support the Chief Compliance Officer and Senior Director, Compliance in preparation and delivery of reports to the ACO-Level Board of Governors, and Executive Management team and Privia Board of Directors .
• Assist in developing and leading education on ACO and Government program compliance activities.
• Perform other duties as assigned.

Qualifications

• Bachelor's degree required
• 8+ years of experience in a health care / managed care organization with demonstrated track record of increasing responsibility and accountability
• In-depth experience with health care payers/ networks, ACO and/or Medicare Advantage Requirements
• Experience in Medicare and Medicaid contracting including demonstration of contracting with health plan C-suite executives and/or government leaders

Colorado, New York, New Jersey, California and Washington Residents Only: The salary range for this role is $112,000 to $168,000 in base pay and exclusive of any bonuses or benefits. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

All your information will be kept confidential according to EEO guidelines.

Technical Requirements (for remote workers):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our go