Health Plan Compliance Auditor
CVS Health•Work At Home-Illinois, IL
•$43,888 - $93,574•Hybrid
About The Position
The Associate, Delegation Compliance supports compliance activities for Oak Street Health’s internal care management and utilization management teams. They partner with operational leadership to implement and monitor ongoing quality improvement activities, lead external compliance and accreditation survey processes, and leverage program knowledge and analytical skills to effectively coordinate all compliance activities.
Requirements
- Bachelor’s degree in Healthcare Administration, Compliance, related field, or equivalent experience
- 1-2 years of compliance experience dealing with care management requirements, utilization management requirements, auditing, reporting processes, action plans, and compliance training preferred
- Strong understanding of healthcare laws, NCQA requirements, and Medicare Part C regulatory compliance in a managed care organization or hospital health care system setting
- Experience working with regulators on compliance audits
- Ability to work independently and with others
- Experience in building and supporting strong teamwork and collaborative communication
- Ability to work under pressure with multiple deadlines and priorities
- Strong problem-solving skills, critical thinking skills, and organizational skills
- US work authorization
- Someone who embodies “Being Oaky”
Responsibilities
- Possesses and demonstrates knowledge of CMS, contractual, accreditation, federal, state, and business requirements for assigned programs, and ensures compliance with program requirements
- Collaborates with leadership to develop, implement, and maintain policies and procedures for assigned programs
- Collaborates with leadership to develop and execute auditing and monitoring tools utilized for staff and program audits
- Collaborates with payers, serves as SME for compliance-related activities
- Contributes to reports used by internal and external leadership
- Provides input and valuable feedback on auditing results, trends and improvement activities
- Recommends process improvement, interventions, and assists with implementation
- Develops and revises training materials based on QA results
- Analyzes processes and key performance indicators to assess compliance risk, internal control, and overall effectiveness and efficiency
- Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practices
- Develops Corrective Action Plans (CAPs) and Performance Improvement Plans (PIPs) and is accountable for the adequacy of operational responses and ongoing monitoring
- Performs other job duties, as assigned.
Benefits
- Mission-focused career impacting change and measurably improving health outcomes for Medicare patients
- Paid vacation, sick time, and investment/retirement 401K match options
- Health insurance, vision, and dental benefits
- Opportunities for leadership development and continuing education stipends
- New centers and flexible work environments
- Opportunities for high levels of responsibility and rapid advancement
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
