Compliance and Regulatory Affairs Manager

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

• Manages day to day functions of the Corporate, Provider, and/or Health Plan Compliance Programs.
• Audits and monitors activities in accordance with the Compliance Work plan; prepares summary reports for leadership.
• Provides education and training to enterprise staff on compliance related issues.
• Assists in coordinating and responding to regulatory policy changes affecting VNS Health operations.
• Collaborates with leadership in developing, reviewing, and revising compliance policies, procedures and related activities for the enterprise. Ensures that enterprise staff are aware of and in compliance with policies and procedures.
• Collaborates with operations to implement corrective actions and implement controls related to identified compliance concerns; evaluates the efficacy of the controls.
• Collaborates with Regulatory Affairs and other internal departments to manage audits conducted by state and federal regulators across VNS Health.
• Collaborates with Human Resources and VNS Health leadership to ensure consistency of disciplinary actions related to matters of non-compliance, especially those related to fraud, waste and abuse and privacy violations.
• Reviews data for patterns and/or trends that may indicate workstream or process concerns involving errors or quality related issues. Prepares reports to communicate key patterns and/or trends and their implications from a compliance/risk perspective. Provides recommendations to address the identified concerns and follows-up with any implemented changes.
• Utilizes data to develop process improvement recommendations. Ensures that regulatory changes or other updates are incorporated into process flows and that concerns are resolved across the appropriate process teams.
• Assists with responses to external requests including, but not limited to, government audits and record requests from oversight agencies.
• Communicates with state and federal regulators in seeking guidance, responding to inquiries, and implementing regulatory updates.
• Creates an environment that encourages the reporting of compliance concerns and allegations.
• Keeps up-to-date regarding compliance, privacy, and vendor oversight laws, regulations, and trends for all VNS Health entities and programs. Serves as a resource to staff regarding compliance-related matters and questions.
• Collaborates with the Risk team to conduct an Annual Risk Assessment, and to develop and implement an Annual Compliance Work plan.
• Oversees sales and marketing activities to ensure regulatory compliance, which includes audits and monitoring various activities.
• Works with Delegated Vendor Operations and Quality to manage any external audit responses required by third parties that support the Health Plans and Provider Services.

Special Investigation Unit (SIU) Only:

• Conducts investigations of allegations or reports of fraud, waste and abuse and/or privacy violations under the direction of compliance and legal counsel leadership, as appropriate. Assists in SIU related investigations.
• Manages the Sanctions & Exclusions process for our team members and external business partners to ensure they go through the seven required databases.
• Participates in special projects and performs other duties as assigned.

Licenses and Certifications:

• Compliance related certification preferred

Education:

• Bachelor's Degree in Business, Health Care Administration, or a related discipline required
• Master's Degree preferred

Work Experience:

• Minimum of four years of progressive experience in a health care compliance or auditing environment required
• Demonstrated knowledge of federal and state health care compliance laws, regulations and requirements required
• Knowledge and experience with compliance requirements applicable to VNS Health Provider Services, Health Plans, and community benefit programs preferred
• Strong written and verbal communication, as well as interpersonal and management skills required