Senior Regulatory Compliance Specialist DSNP

The Sr. Regulatory Compliance Specialist is responsible for assisting with the implementation and managing of the organization’s Compliance Program. This position will assist in the development and implementation of all facets of the Compliance Program, including but not limited to problem identification, monitoring and oversight of activities in support of the Compliance Program, and investigation of compliance concerns. Supports the execution and development of the Annual Compliance Work Plan, may also lead special projects, in addition to the day-to-day responsibilities of researching and staying abreast of specific regulatory requirements. Research, analyze and interpret applicable regulations relevant to Federal, State and local laws and recommend deliverables, enhancements to processes, policies, procedures and contracts for all business areas. Facilitate the implementation of regulatory policies, working closely with legal and all impacted business areas.

Actively participate in compliance audits, investigations, and corrective action plans

Responsible for evaluating company compliance with client and regulatory agency requirements, identifying potential areas of non-compliance, disseminating corrective action plan objectives, and assisting with the development of solutions and/or responses to ensure the best possible audit outcome

Keep stakeholders informed of the outcomes, issues, and concerns regarding the audit process, associated results, and facilitate/monitor corrective action progress

Document compliance activities in the organization’s Compliance Program, and track and report on all assigned activities

Participate in the planning and performance of the annual compliance risk assessment process

Participate in the development and execution of the annual compliance work plan and related documents

Support leadership with the coordination, implementation, and oversight of monitoring activities related to the Compliance Program, this includes management of third-party consultants/vendor

Prepare requested reports by collecting, analyzing, and summarizing relevant information obtained through internal and external audits, investigations, work plan submissions, and other compliance activities

Assist with the development, distribution, implementation, and tracking of compliance forms, documents, policies, and training materials in support of the Compliance Program

Develop and maintain a working knowledge of relevant laws, rules, and regulations governing the healthcare services furnished by the company

Assist business partners in fully understanding regulatory requirements and assist in identifying methods and alternatives for implementation into the company’s environment

Maintain timely communication with the leadership on compliance concerns that have been reported and/or observed

Job Specifications

Typically has the following skills or abilities:

Bachelor’s Degree in Business or related field or equivalent experience. Master’s degree preferred

Minimum of six years of experience and expertise in contributing, implementing and leading compliance programs in healthcare organizations

Certified in Healthcare Compliance (CHC) required within 24 months of hire

Demonstrated knowledge in Managed Care Compliance

Expert level of knowledge of state and federal health care statutes, regulations, laws, and policies

Demonstrated organization, facilitation, communication, and presentation skills

Ability to act quickly and efficiently in emergent situations

Proven analytical, critical, creative thinking, problem-solving, and project management skills to develop, and implement policies. Professional level written and verbal communication skills

Ability to assist in effectively communicating with policymakers, stakeholders, regulators, and executives both orally and in writing

Ability to assess risk and design mechanisms to mitigate risk

Demonstrated ability to problem-solve, prioritize work, meet deadlines, and provide independent strategic direction/decision-making

Ability to work with minimal direction/supervision; work with multiple tasks, challenging situations, and meet deadlines

Ability to handle confidential information

Ability to regularly exercise discretion and independent judgment in the performance of job duties

Preferred Skills

*MUST HAVE* DSNP, Medicare, Medicaid Government Program Expertise

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Compensation range for the role is listed below. Applicable salary ranges may differ across markets. Actual pay will be determined based on experience and other job-related factors permitted by law. As a part of the compensation package, this role may include eligible bonuses and commissions. For more information regarding VSP Vision benefits, please click here. 

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