Chief Ethics, Compliance and Risk Officer

Chief Ethics, Compliance and Risk Officer

Company: AHI agilon health, inc.

Location:

Remote – United States

The Chief Ethics, Compliance and Risk Officer (CCO) serves as a strategic partner to senior leadership, integrating compliance, ethics, and risk considerations into business planning, growth initiatives, and decision‑making across the enterprise.

• Strategic Advisory & Business Partnership
  
  • Advise senior leaders on healthcare regulatory matters and strategic initiatives in Medicare Advantage, ACO, and value‑based care models.
  
  • Provide proactive compliance guidance for complex transactions, market expansion, and partner relationships.
  
  • Ensure communications related to Markets, ACO, and Growth meet business objectives while maintaining regulatory compliance and protecting confidential information.
• Compliance Leadership & Risk Management
  
  • Develop and implement comprehensive compliance and risk‑management programs aligned with enterprise strategy.
  
  • Oversee compliance operations across healthcare, corporate governance, privacy, and other regulatory domains.
  
  • Design and monitor internal controls, risk assessment initiatives, and policy development that balance business enablement with regulatory compliance.
  
  • Build a compliance culture through training, communication, and stakeholder engagement.
• Compliance Program Operations
  
  • Communicate the importance of the Compliance Program to executive management and the Board.
  
  • Prepare and distribute the written Code of Conduct, establishing ethical principles and policies.
  
  • Implement education programs, maintain retaliation‑free reporting systems, and review the program for continuous improvement.
  
  • Ensure internal controls detect and prevent violations related to Medicare billing, marketing regulations, fraud, abuse, and privacy.
• Enterprise Risk Management
  
  • Establish ERM framework, governance structure, risk appetite, and operating cadence.
  
  • Design and implement enterprise risk identification, assessment, and prioritization across strategic, operational, regulatory, financial, and reputational domains.
  
  • Report key risk indicators, emerging risks, and risk insights to the CEO, executive team, and Board on a regular cadence.
  
  • Champion a culture of proactive risk awareness and embed risk management capabilities across business units.
• ACO Program Compliance Support
  
  • Serve as primary compliance resource for ACO programs (REACH, MSSP, LEAD).
  
  • Review and advise on ACO participation agreements, CMS data use agreements, and procurement processes.
  
  • Monitor rule making and policy changes, conduct compliance training, and coordinate with Legal, Finance, and Operations on attestation and reporting obligations.
• Clinical Documentation, Coding Compliance & Audit Oversight
  
  • Oversee coding compliance, risk adjustment data validation, retrospective and prospective coding reviews, and CDI initiatives.
  
  • Coordinate audit response strategies, corrective action plans, and reporting to the Board.
  
  • Maintain an internal audit framework, identify documentation or coding risk patterns, and implement remediation programs.
• Other Job Functions
  
  • Demonstrate rigorous attention to detail and accuracy.
  
  • Provide client service and manage multiple high‑priority work streams simultaneously.
  
  • Perform special projects, analyses, and additional duties as assigned.

• 10+ years of progressive compliance experience with at least 5 years in a senior compliance leadership role at a healthcare organization.
• Demonstrated experience building and leading enterprise 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 related compliance domains (fraud, abuse, privacy, billing, marketing).
• Experience managing relationships with and presenting to executive management, boards, and regulatory bodies.
• Strong business acumen and strategic thinking with ability to translate complex regulatory requirements into actionable business guidance.
• Excellent written and verbal communication skills with professionalism and…