Senior Network Regulatory Specialist

The Senior Network Regulatory Specialist is responsible for assisting with the implementation and management 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/vendors

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

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.

VSP Vision is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to age, gender, race, color, religion, sex, national origin, disability or protected veteran status. We maintain a drug-free workplace and perform pre-employment substance abuse testing.

Unincorporated LA County Residents: Qualified Applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act, and any other similar laws.

Notice to Candidates: Fraud Alert - Fake Job Opportunity Solicitations Used to Collect Fees/Personal Information.

We have been made aware that fake job opportunities are being offered by individuals posing as VSP Vision and affiliate recruiters. Click here to learn about our application process and what to watch for regarding false job opportunities.

As a regular part of doing business, VSP Vision (“VSP”) collects many different types of personal information, including protected health information, about our audiences, including members, doctors, clients, brokers, business partners, and employees. VSP Vision employees will have access to this sensitive personal information and are subject to follow Information Security and Privacy Policies.

Originally posted on Himalayas

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