The ACO Compliance Program Analyst (the “Program Analyst”) is responsible for the day-to-day operations of the DH ACO Compliance Program. The Program Analyst directs the execution of proactive and reactive compliance activities, as well as maintains the core elements of the ACO Compliance Program. The role will also administer oversight to comply with Medicare Advantage directed First-Tier Downstream Related Entity (FDR) compliance program. Administration activities will include, but are not limited to, readiness audits and execution of payer attestations intended to meet CMS regulatory requirements and promote an effective compliance program across DH.

1. ACO Responsibilities:
2. Maintains current knowledge of applicable federal and state laws and other compliance regulations related to the ACO Shared Savings Program in collaboration with DH Corporate Compliance. Monitors compliance and audit standards and changes in regulations to ensure adaptation and compliance.
3. Develops action plans for improvement and regulation changes to support departmental goals and objectives increasing performance and improve outcomes.
4. Ensures important deadlines and requirements are met and communicated to the director, leadership, providers, and departments as necessary.
5. Analyzes data for aggregation and reporting, and proactively monitors progress of measures to prevent monetary penalties of providers and participants.
6. Facilitates compliance with value-based payment programs objectives by reviewing individual provider, clinic, and participant reports to identify potential issues and create appropriate interdepartmental resolutions.
7. Provides ongoing strategic recommendations and manages strategic initiatives for the ACO with collaboration of providers and departments.
8. Provides ongoing communication with care coordinators, providers, participants, and departments to ensure team members receive appropriate information and training to achieve objectives related to high-quality and cost-efficient care.
9. Supports Compliance Leadership and operations team to include the physician liaisons to improve efficiency of current workflow, collaboration with providers and strategic initiatives.
10. Performs an annual Risk Assessment and participates in the development, implementation and reporting of an annual ACO Work Plan.
11. Performs auditing and monitoring of select risk topics for the Member as identified by the OIG Work Plan, internal recommendation and/or determination from other regional and national relevant areas of focus for the ACO Shared Services Program.
12. Performs other duties as required or assigned.
13. First-Tier Downstream Entity Readiness Responsibilities:
14. Maintains current knowledge of applicable federal and state laws and other compliance regulations related to the First-Tier, Downstream and Related Entity (“FDR”) Medicare Compliance Program Guidance in collaboration with DH Corporate Compliance. Monitors compliance and audit standards and changes in regulations to ensure adaptation and compliance.
15. Collaborates with DH Contracting and the Medical Staff Office, and other stakeholders, to assess the organization’s ability to perform the delegated compliance program functions as outlined by the individual Medicare Advantage Plans.
16. Develops and implements a standard process for determining the requirements for responding to FDR audits and attestations. Maintains a database for tracking of FDR requests, findings and completes subsequent reporting to leadership, as requested.
17. Performs periodic internal auditing and monitoring to verify assurance with FDR compliance program elements.
18. Performs other duties as required or assigned

• Bachelor’s Degree required.



• Preferred MBA, MHA, JD with major coursework in business administration, health care administration, or law preferred.



• Preferred ACO Compliance experience.



• A minimum of three years of health care compliance experience, preferably in a large Healthcare system setting or in a consulting capacity

• Preferred CHC or other compliance certifications.