Overview:
Responsible for planning, coordination, and conducting comprehensive compliance audits and reviews to assess adherence to regulatory requirements, contractual obligations, and internal policies for VNS Health. Additionally, will provide updates and recommendations to Management on quality and delegation oversight responsibilities, participate in fraud, waste, and abuse investigations as applicable, and oversee pre-delegation and annual audits for new and existing delegated entities to drive continuous improvement and adherence to regulatory standards by ensuring delegates are compliant with regulatory requirements. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff
Responsibilities:
What We Provide
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
- Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement
- Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
What You Will Do
- Analyzes and interprets contractual, state, and federal regulatory, and accreditation requirements. Stays abreast of changes in healthcare regulations, laws, and industry standards; analyzes regulatory developments and assesses their impact on the organization.
- Participates in and conducts compliance functions, including, but not limited to, develops audit tools and validates implementation of new requirements and corrective action plans.
- Collaborates with cross-functional teams, including Legal, Compliance, Quality, and Operations, to address compliance-related challenges and implement effective solutions. Works with internal business units to prepare reports for distribution to internal Committees and external entities.
- Works with internal business units and/or external entities to correct performance deficiencies.
- Delivers regulatory trainings for internal business units and/or external entities.
- Facilitates and participates in vendor related projects.
- Assists in the development, review, and updating of policies, procedures, guidelines compliance work plans, to ensure alignment with regulatory requirements and industry best practices.
- Conducts audits of VNS Health Health Plans/Vendors.
- Updates existing audit tools based on regulatory changes.
- Leads entrance calls, exit conferences, and technical calls with delegates. Collaborates with cross-functional teams, including but not limited to Legal, Compliance, Quality Assurance to address compliance-related challenges and delegate's performance deficiencies, and implement effective solutions. Assists management to establish processes to track program effectiveness; monitor and analyze data to identify trends and areas for improvement. Works closely with Delegation Oversight Audit management on and to co-lead projects.
- Performs other duties as assigned.
- Participates in special projects and performs other duties as assigned.
Qualifications:
Education: Bachelor's Degree or equivalent education and/or related experience required
Work Experience:A least 4 years of audit experience in compliance, delegation oversight, or audit within the healthcare industry required
Demonstrated experience in delivering training programs and making presentations to internal staff and providers required
Knowledge of New York State Department of Health (SDOH), Centers for Medicare and Medicaid Services (CMS), requirements required
Highly developed analytical and critical thinking skills required
Ability to manage multiple priorities, projects and meet deadlines required
Excellent verbal and written communication skills required
Proficient in Microsoft Office, Excel, and PowerPoint required
Knowledge of policies and procedures preferred
Pay Range:
USD $93,400.00 - USD $116,800.00 /Yr.