Job Description

COMPANY DESCRIPTION

WellMed Optum Florida is an independent, Florida-focused organization dedicated to delivering high-quality care to seniors and the communities it serves. The organization emphasizes coordinated, patient-centered care that supports healthier outcomes and improved quality of life. Team members collaborate across disciplines to provide services that are both compassionate and data-informed. WellMed Optum Florida offers opportunities to contribute to meaningful work in a mission-driven environment with a strong focus on compliance, quality, and operational excellence.

ABOUT THE ROLE

The Compliance Analyst supports the organization’s compliance program, based on the Seven Elements of an Effective Compliance Program, through analytics, monitoring, testing, issue management, audit coordination, and executive reporting. This individual contributor role partners with Legal, Compliance, Internal Audit, Operational Leaders, and Risk Management teams, providing data-driven insights and tracking corrective actions across WellMed Optum Florida's 94 medical clinic locations and approximately 1,600 employees.

The role operates within a full-risk, value-based care environment serving Medicare Advantage payor groups, with a focus on ensuring adherence to CMS regulations, the Federal Anti-Kickback Statute (AKS), Stark Law, Medicare marketing guidelines, HIPAA, and applicable state and federal healthcare laws. Responsibilities include identifying trends, monitoring compliance risks, supporting audit and regulatory readiness, maintaining issue-management processes, and developing reporting materials for leadership committees and governance bodies.

This is a hybrid position however you are required to live within a commutable distance to Tampa, FL. This role will be reporting directly to the Director of Compliance and Privacy Officer within the Legal & Compliance Department. The role requires periodic travel to WellMed Optum Florida clinic sites across Florida to support compliance monitoring, auditing, and corrective action activities.

WHAT YOU’LL DO

Supporting Legal and Compliance leadership:

Compliance Analytics and Monitoring

• Develop, maintain, and refine compliance dashboards, scorecards, and key risk indicators across Wellmed Optum’s clinic and corporate operations.
• Collect, analyze, and interpret compliance-related data to identify trends, emerging risks, and areas requiring corrective action.
• Produce recurring and ad hoc reports for Compliance leadership, Legal leadership, and executive stakeholders.
• Monitor compliance performance metrics and assist in evaluating program effectiveness.
• Conduct data validation and quality reviews to ensure reporting accuracy and consistency.

Compliance Testing and Audit Support

• Support compliance testing and monitoring activities, including the development and execution of compliance testing plans and workpapers.
• Compile, organize, and validate documentation requested during internal audits, compliance reviews, and regulatory examinations.
• Coordinate audit requests, partnering with the audit teams, and facilitate timely responses from business stakeholders.
• Track findings, recommendations, and remediation activities resulting from audits and compliance reviews.

Regulatory Compliance and Clinic Operations

• Conduct routine compliance monitoring and auditing activities across clinic operations
• Track and analyze regulatory changes affecting value-based care arrangements, Medicare Advantage plans, and full-risk capitation agreements.
• Coordinate with clinic operations leadership to ensure timely completion of corrective action plans resulting from compliance reviews, audits, or regulatory findings.
• Support field-level compliance assessments to verify adherence to CMS regulations, the Federal Anti-Kickback Statute, Stark Law, and applicable state and federal healthcare requirements.

Issue Management and Remediation Tracking

• Maintain centralized tracking of compliance issues, audit findings, corrective action plans, and remediation activities across all clinic and corporate operations.
• Monitor issue aging, escalation requirements, and action plan completion status.
• Partner with operational leaders to obtain updates and supporting evidence for remediation efforts.
• Escalate overdue or high-risk compliance issues in accordance with established governance protocols.

Governance and Leadership Reporting

• Prepare materials for Compliance Committee, Executive Leadership Team, Board, and other governance meetings.
• Develop presentations, dashboards, and executive-level summaries highlighting compliance trends, audit results, and risk indicators.
• Maintain governance documentation, meeting records, action item logs, and reporting calendars.
• Support annual compliance work plans, risk assessments, and program reporting activities

Compliance Program Support

• Support the development, implementation, and maintenance of compliance policies and procedures aligned with CMS, OIG, and state regulatory requirements.
• Support Medicare marketing material review for compliance with CMS Medicare Communications and Marketing Guidelines (MCMG).
• Maintain compliance training records and assist in developing training content for clinical and administrative staff.
• Monitor exclusion screening (OIG/SAM) for employees, contractors, and vendors.
• Assist with regulatory filings, disclosures, and government audit responses.
• Assist in investigating compliance concerns, hotline reports, and potential violations; document findings and corrective actions.
• Collaborate with Legal, Human Resources, Clinical Operations, Revenue Cycle, Privacy, and Internal Audit teams on cross-functional compliance matters.

WHAT YOU’LL BRING

Required Qualifications

• Bachelor’s degree in Business, Healthcare Administration, Finance, Analytics, Accounting, Legal Studies, Public Health, or a related field.
• 3+ years of experience in healthcare compliance, audit, risk management, legal operations, regulatory reporting, analytics, or a related field.
• Working knowledge of the Seven Elements of an Effective Compliance Program, CMS regulations, the Federal Anti-Kickback Statute (AKS), Stark Law, HIPAA, and FWA requirements.
• Experience supporting audits, compliance testing, monitoring activities, or issue management processes.
• Advanced proficiency in Microsoft Excel, including data analysis, pivot tables, and reporting; proficiency in the broader Microsoft Office suite.
• Experience creating executive-level reports, dashboards, and presentations.
• Strong analytical, organizational, and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities and meet deadlines in a highly regulated environment.
• Ability to travel to clinic sites across Florida as needed.

Preferred Qualifications

• Experience in healthcare, managed care, value-based care models, risk-based contracting, physician practice management, or health services organizations.
• Knowledge of healthcare regulatory requirements including Medicare, Medicaid, HIPAA, FWA, and compliance program expectations.
• Experience with compliance management, governance, audit, risk, or issue-tracking systems, including compliance management software.
• Familiarity with Power BI, Tableau, SQL, or other business intelligence tools.
• CHC (Certified in Healthcare Compliance) certification, or willingness to obtain within 18 months of hire. CCEP, CIA, CRCM, or similar credentials also valued.

Wellmed Optum is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, genetic information, or any other characteristic protected by applicable federal, state, or local law.

Wellmed Optum is committed to providing reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act (ADA) and applicable state laws. Applicants who require accommodation should contact Human Resources.

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