The Senior Regulatory Compliance Specialist is responsible for assisting with implementation and maintenance of the company’s Compliance Software Program, Metric Stream in managing the organizations Medicare and Medicaid Compliance Program. The Senior Regulatory Compliance Specialist will assist in the development and implementation of all facets of the Compliance Program, including but not limited to compliance training, monitoring and oversight of activities in support of the Compliance Program, and investigation of compliance concerns. Supports the execution of the Annual Compliance Work Plan, may also lead special projects as assigned by the Senior Compliance Manager, in addition to the day-to-day responsibilities of researching and staying abreast of specific state regulatory requirements for assigned states.

Actively participate in compliance investigations and corrective action plans.

Document compliance activities in the Compliance Software 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

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

Perform and document Work Plan activities as assigned

Prepare requested reports by collecting, analyzing, and summarizing relevant information obtained through 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

Research compliance topics as requested. Recommend proposed actions based on research results

Assist with the daily operational and functional requirements of the Compliance Department

Maintain timely communication with the Senior Compliance Manager and VP of

General Counsel on compliance concerns that have been reported and/or observed

Deliver exceptional customer service to internal business partners while balancing multiple competing interests and projects or considerable complexity.

Other duties as assigned as necessary which promotes and maintains the Compliance Program.

Job Specifications

Typically has the following skills or abilities:

Bachelor’s Degree in Business or related field or equivalent experience

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

Experienced in Managed Care Compliance

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

Demonstrated organization, facilitation, communication, and presentation skills

Ability to act quickly and efficiently in emergent situations

Exceptional analytical, critical, creative thinking 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

Excellent interpersonal skills

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 his/her job duties

Preferred experience with NCQA credentialing accreditation, Medicare and Medicaid (All 50 states), CMS and network and provider compliance.

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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. 

Salary Ranges: $80,000.00 - $135,000.00

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, gender identity, sexual orientation, disability or protected veteran status.  We maintain a drug-free workplace and perform pre-employment substance abuse testing.

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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.