Compliance Officer

About the role

The Compliance Officer contributes to AHF by instituting and maintaining an effective compliance program for the organization’s Medicare and Medi-Cal managed care plans and Ryan White programs. This includes policies and procedures; standards of conduct; fraud, waste, and abuse monitoring and reporting; and HIPAA.

As part of the Care Management Division’s executive management team, the Compliance Officer stays abreast of regulatory changes and requirements related to operations and guides Division leaders on needed changes to policies, procedures, and reporting. The Compliance Officer leads internal and external audit preparation and activities and oversees the timely preparation and submission of reports to regulatory agencies.

The Compliance Officer enhances the reputation of AHF by ensuring that Care Management Division operations are compliant with Centers for Medicare and Medicaid (CMS), California Department of Health Care Services (DHCS), California Department of Managed Health Care (DMHC), and Ryan White program funder regulatory and contract requirements. This maintains enrollee, patient, provider, and funder satisfaction with the organization.

You will be a passionate advocate for AHF’s top initiatives, ensuring that the AHF Core Values and Mission stay top of mind in all activities. The role operates within a collaborative organizational structure where staff are accountable to multiple leaders, working as part of a close-knit team to mitigate compliance risk and position the organization for growth opportunities.

Responsibilities

• Institute and maintain an effective compliance program for Medicare and Medi-Cal managed care plans and Ryan White programs, including policies, procedures, standards of conduct, and fraud, waste, and abuse monitoring.
• Monitor and report on compliance with HIPAA regulations.
• Stay current with regulatory changes and requirements, guiding Division leaders on necessary updates to policies, procedures, and reporting.
• Lead internal and external audit preparation and activities.
• Oversee the timely preparation and submission of reports to regulatory agencies.
• Ensure compliance with CMS, DHCS, DMHC, and Ryan White program funder requirements to maintain stakeholder satisfaction.
• Advocate for AHF’s core initiatives while aligning with the organization’s mission and values.
• Collaborate with a cross-functional team to mitigate compliance risks and support organizational growth.

Requirements

• Experience in compliance program development and management, particularly in healthcare or managed care settings.
• Knowledge of Medicare, Medi-Cal, Ryan White programs, HIPAA, and relevant regulatory frameworks (CMS, DHCS, DMHC).
• Ability to interpret and apply regulatory changes to operational policies and procedures.
• Experience leading audit preparation and regulatory reporting.
• Strong leadership and collaboration skills within a dynamic, multi-leader organizational structure.
• Commitment to AHF’s mission, values, and initiatives.