Compliance Operations Specialist

Provides project management and data analysis support for the organization's Compliance programs. Assists in the prevention and detection of issues related to regulatory non-compliance, fraud and abuse for all VNS Health lines of business. Responsible for reviewing, auditing, and analyzing the accuracy and effectiveness of VNS Health operational systems, including those delegated to subcontractors. Prepares audit reports, recommends/manages corrective actions, and follows up to ensure corrective actions have been implemented. Assists in facilitation of external audits and regulatory survey visits. Participates in design and implementation of monitoring systems to manage each program more efficiently and effectively. Works under general supervision.

$70,200.00 - $87,700.00 Annual

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

• Implements auditing procedures to be used to evaluate VNS Health compliance with organization/program policies and procedures, as well as applicable laws and regulations.
• Evaluates areas under review to ensure operational and/or internal control activities are in compliance with management instructions, applicable policies and procedures, government or contractual requirements, and high standards of practice. Prepares working papers and documentation in support of audit results and any conclusions and recommendations.
• Follows up on completed audits to ensure recommended actions have been adopted and to re-assess areas identified for improvement.
• Keeps abreast of changes to the field of compliance and auditing.
• Researches and compiles information on emerging trends, government priorities in fraud/abuse detection, and incorporates information, as appropriate, into audit planning.
• Drafts written audit reports and presents oral reports to Compliance and Regulatory Affairs leadership, as well as other VNS Health management staff.
• Assists in preparation for external audits/regulatory surveys and facilitates work of auditors/surveyors when they are on-site.
• Maintains departmental compliance software system, including uploading new information, granting and amending user access, executing reports and managing completion of system-driven projects.
• Develops and maintains comprehensive monitoring and tracking tools to support complete, accurate and timely deliverables to regulatory agencies.
• Assists with disseminating regulatory updates; develops and maintains a comprehensive tracking tool to ensure timely action is taken.
• Ensures that regulatory changes or other updates, including corrective actions, are incorporated into process flows and that concerns are resolved across the appropriate process teams.
• Updates Compliance document libraries, which includes but is not limited to, investigative information, audits, reports, workplans, EthicsPoint, GRC tool, policies and procedures, and training materials.
• Participates in defining the scope of projects, developing project plans, and ensuring forward momentum of projects toward stated goals. Tracks and monitors project work plans, including objectives, tasks and time frames, to ensure deliverables are completed on time.
• Coordinates the completion of Compliance activities, including Board and Audit Committee reports and Compliance Committee reports.
• Demonstrates a commitment to excellent customer service through prompt responses to internal and external customers.
• Participates in special projects and performs other duties as assigned.

Education:

• Bachelor's Degree in business administration, public administration, public health, or similar field, or the equivalent work experience, required
• Master's Degree in business administration, public administration, public health, or similar field, preferred

Work Experience:

• Minimum of three years of experience in regulatory compliance, auditing or related experience, required
• Excellent oral communication and strong writing ability, required
• Knowledge of federal and state regulatory requirements for managed care organizations, preferred