Health Plan Compliance Auditor

About the role

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.

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
• 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
• 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.

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
• Experience in building and supporting strong teamwork and collaborative communication
• Experience in working under pressure with multiple deadlines and priorities
• Strong problem-solving skills, critical thinking skills, and organizational skills

Qualifications

• US work authorization

Skills

• Radiating positive energy
• Creating an unmatched patient experience
• Driving clinical excellence
• Taking ownership and delivering results
• Being relentlessly determined

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

Pay

The Typical Pay Range For This Role Is $43,888.00 - $93,574.00

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility

Anticipated Weekly Hours

40

Time Type

Full time