Title:Program Integrity Clinical Compliance Auditor Location: United States Job Description: This position is Remote in Massachusetts. You will have the flexibility to work remotely* as you take on some tough challenges. Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. The Program Integrity Clinical Compliance Auditor will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive conduct by health care providers who submit claims for payment. This position will utilize information from claims data analysis, plan members, the medical community, law enforcement, employee conduct, and confidential investigations in order to document relevant findings. The Sr. Recovery Resolution Analyst will conduct site visits and desk audits of provider claims, and medical and administrative records, to gather and analyze all necessary information to determine whether subject adhered to state and federal compliance policies, reimbursement policies, and contract compliance. The Sr. Recovery Resolution Analyst will present and discuss audit findings with client and input information into Optum audit workflow tools and the client's case tracking system. Where applicable, the Auditor will support appeal and fraud investigation activities. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm local time. It may be necessary, given the business need, to work occasional overtime. We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule. Primary Responsibilities: - Review medical and administrative records for audit/compliance review - Travel to provider sites up to 25%/month to collect records and engage with providers - Present and participate in discussions with the client regarding audit observations and findings - Collaborate with a team of 2-5 auditors to complete reviews - Enter audit findings data and notes in online/electronic platform using Excel-based templates - Attend and participate in dispute reviews and administrative hearings - Demonstrated written and verbal communications skills - Demonstrated customer service skills You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: - High School Diploma / GED OR equivalent work experience - Must be 18 years of age OR older - Nurse licensure (RN or LPN) with a current, active, and unrestricted license in Massachusetts - Must have a Valid Driver's license - 2+ years of experience reviewing health care documentation in a clinical or administrative role - Experience with MS Office Suite, specifically Word, PowerPoint, and Excel (including familiarity with basic formulas and data analysis) - Ability to travel up to 25% of the time within the state of Massachusetts as business needs dictate - Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm local time. It may be necessary, given the business need, to work occasional overtime Preferred Qualifications: - Clinical or administrative experience in long term care, for example, nursing facility care delivery/administration and/or community-based LTC service programs like Home Health - Experience in claim processing, healthcare provider information, and healthcare billing practices - Experience working in a remote/telecommute workspace - Working knowledge of medical terminology and claim coding with familiarity of CPT-4, HCPCs and ICD-10 code terminology - Familiarity with Medicaid program and/or billing requirements Telecommuting Requirements: - Reside within Massachusetts. - Ability to keep all company sensitive documents secure (if applicable) - Required to have a dedicated work area established that is separated from other living areas and provides information privacy. - Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service. *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

Title : Compliance Coordinator II Location: Philadelphia United States Job Description:Philadelphia, Pennsylvania - Full time - Opening on: Jun 15 2026 - Remote - Ascensus Add to favorites View favorites Ascensus is the leading independent technology and service platform powering savings plans across America, providing products and expertise that help nearly 16 million people save for a better today and tomorrow. Section 1: Position Summary This position is responsible for supporting our clients compliance related requirements and requests though leveraging experience, knowledge and independent resolution to achieve client satisfaction. An additional responsibility of this position includes independently working on initiatives to help support client satisfaction. This position is also responsible for providing leadership by example and serving as a technical resource to ensure client expectations are met and/or exceeded. Section 2: Job Functions, Essential Duties and Responsibilities - To assist our clients with their annual IRS reporting requirement, prepare and quality control IRS Large Form 5500, inclusive of all appropriate schedules and reconciliations which include Schedule C. - Expertise with annual Compliance testing (ADP/ACP, 410(b) 415, 402(g)) as required for clients. - Perform and quality control advanced client requested calculations which include Profit Sharing integrated, QNEC, QMAC, Match contributions and review of plan document to ensure that provisions have been correctly applied to the calculation. - Expertise associated with plan documents to assist with client resolution. - Support Client Service teams through timely comment resolution and phone support including external conference calls to assist with client resolution. - Participate in annual Post Mortem meetings that are held in collaboration with other teams throughout the organization to continuously improve the Client Experience. - As a Compliance Service''s subject matter expert, review and update training materials for instructor led courses as well as assisting the Training team with presenting the material. - Train and mentor associates in Compliance Services to ensure processes are reviewed to determine that the best client experience is being provided. - Ability to take lead or participate on special projects within the Compliances Services department or represent Compliance Services on cross-departmental projects or initiatives. This includes providing status update to the Compliance Services team. - Assist the Leadership team with the review and quality control of external communications sent to our clients. - Responsible for protecting, securing, and proper handling of all confidential data held by Ascensus to ensure against unauthorized access, improper transmission, and/or unapproved disclosure of information that could result in harm to Ascensus or our clients. - Our I-Client service philosophy and our Core Values of People Matter, Quality First and Integrity Always should be visible in your actions on a day to day basis showing your support of our organizational culture. Supervision - As a Compliance Service''s subject matter expert, review and update training materials for instructor led courses as well as assisting the Training team with presenting the material. - Train and mentor associates in Compliance Services to ensure processes are reviewed to determine that the best client experience is being provided. Section 3: Experience, Skills, Knowledge Requirements - A minimum of 4 years industry experience in retirement services environment, including compliance testing and 5500 experience. - Ability to make sound business judgments while effectively balancing client needs and organizational considerations. - Advanced analytical and problem solving skills. - Ability to work additional hours as necessary to meet business needs. - Consistently demonstrate an advanced level of proactive client focus. - Ability to work with a high level of independence. - Ability to work within a team structure to ensure common goal of providing exceptional customer service. - Strong coaching and mentoring skills. - Strong knowledge base of ERISA, DOL and IRS regulations, and plan documents (individually designed and prototype).

Role Description Responsible for A/R, and mail follow-up on amounts due from Payor’s, and third-party’s on a timely basis in accordance with CBO policies for facilities assigned. Responsibility for timely collections and third-party follow-up. Performs other related duties as assigned or requested. This is a non-exempt position. - Provide support to all facilities when requests are received or assistance is needed. - Be timely and responsive to all requests. - Treat our facilities with respect. - Respects dignity and confidentiality by adherence to all applicable policies and procedures. - Promotes the Mission and Vision of Post Acute Medical within the work environment and the community. - Maintains the highest level of customer service via courtesy, compassion and positive communication. Qualifications - Payment posting - Collection - Medical collections - Medical - Payment poster - Data entry - Customer service - Medical billing - Call center - Medicaid - Collection calls - Revenue cycle - Outpatient Requirements - Collection - Customer Service - Maintains the highest level of customer service via courtesy, compassion and positive communication. - Promotes the Mission and Vision of Post Acute Medical within the work environment and the community. - Respects dignity and confidentiality by adherence to all applicable policies and procedures. - Represented as a Leader of the RCO Department. - Maintain the highest level of Compliance Standards. Benefits - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave) Company Description We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

Role Description Chief Ethics, Compliance and Risk Officer - 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 healthcare regulatory matters affecting business operations, market strategy, and strategic initiatives across Medicare Advantage, ACO, and value-based care models. - Support complex transactions, new market expansion, and partner relationships by providing proactive compliance guidance that facilitates execution while protecting the organization. - Ensure company and partner communications related to Markets, ACO, and Growth achieve 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 enterprise level. - 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 and compliance monitoring systems. - Lead risk assessment initiatives in partnership with enterprise 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 agilon health enterprise; prepare and distribute the written Code of Conduct; set forth the ethical principles and policies which form the basis 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 within 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 agilon health 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. - Enterprise Risk Management: - Lead agilon’s Enterprise Risk Management (ERM) function, establishing the framework, governance structure, risk appetite, and operating cadence in partnership with Internal Audit and senior leadership. - Design and implement an enterprise risk identification, assessment, and prioritization process that covers strategic, operational, regulatory, financial, and reputational risk domains. - Partner with Internal Audit to align ERM and audit activities, ensuring risks are appropriately covered, escalated, and tracked without duplication of effort. - Develop and maintain the enterprise risk register; report on key risk indicators and emerging risks to the CEO, executive team, and Board on a regular cadence. - Integrate ERM 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 REACH, MSSP, and ACO LEAD, providing guidance on CMS participation requirements, program integrity obligations, and regulatory compliance. - Review and advise on ACO participation agreements, CMS data use agreements, and program-related contracting, escalating complex matters 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-related compliance training for physician partners, affiliated providers, and internal teams, ensuring awareness of program integrity 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 related to ACO program compliance. - Clinical Documentation, Coding Compliance & Audit Oversight: - Provide compliance oversight for agilon’s clinical documentation and coding programs, ensuring that risk adjustment coding practices, HCC capture methodologies, and documentation standards comply with CMS requirements, Medicare Advantage regulations, and applicable fraud and abuse laws. - Oversee 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 enterprise compliance lead for all 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 framework 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 cadence. - 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. - Provide 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-priority workstreams simultaneously. - Performs special projects and analyses, as well as additional duties as assigned. Qualifications - 10+ years of progressive compliance experience, with a minimum of 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 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 complex 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. Requirements - 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 related to compliance (e.g., CCEP, CHC, CIPP-US). - Experience with ACO regulatory frameworks (REACH, MSSP, LEAD) and Medicare Advantage star ratings economics. - Prior experience serving as CCO or Deputy CCO at a publicly traded healthcare company. - Familiarity with the post-Loper Bright legal environment and its implications for agency deference in healthcare 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 complex, high-growth environment. - Reasoning Ability: Ability to apply compliance and legal reasoning and sound judgment to complex, novel regulatory problems with incomplete information. - Computer Skills: Ability to create and maintain documents using Microsoft Office (Word, Excel, Outlook, PowerPoint); familiarity with compliance management, matter management, or GRC platforms preferred. - Other Skills and Abilities: Working knowledge of federal healthcare regulatory frameworks including AKS, Stark 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 matters. Protect yourself: agilon health will never send unsolicited job offers or request payments or financial information. Such communications are fraudulent. This position is not eligible for current or future sponsorship or employer-supported work authorization by agilon health. Applicants must be able to accept and maintain employment with agilon health in the United States for the full duration of their employment without sponsorship or work authorization support. Location: Remote - IL Pay Range: Salary range shown is a guideline. Individual compensation packages can vary based on factors unique to each candidate, such as skill set, experience, and qualifications.