Compliance Partner (Remote)

LOCATION: Remote - this is a home based, virtual position that operates Monday - Friday from 8:30am-5:00pm (EST). Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL. North Carolina residency preferred.

GENERAL STATEMENT OF JOB

The Compliance Partner is responsible for conducting internal audits, investigations, member and provider grievances related to staff within the Quality Management Department, implementation of internal corrective action plans, and policy and procedure management. This position plays a key role in ensuring the organization's continued compliance with state and federal laws, rules, regulations, contract requirements, and accreditation standards. The Compliance Partner maintains a working relationship with various cross-functional teams, departments and committees to ensure business processes are monitored, verified and corrected as needed.

ESSENTIAL JOB FUNCTIONS

Regulatory, Contractual and Accreditation Compliance:

• Develop and maintain audit tools utilizing regulatory, statutory, contractual, and accreditation requirements to assist in identifying areas of non-compliance and monitoring of performance standards through conducting internal audits.
• Assist in the development and monitoring of plans of correction resulting from internal audits, investigations and as requested by regulatory or accrediting bodies in response to identified areas of non-compliance.
• Develop and maintain internal investigation plans for the purpose of conducting internal investigations and applicable interviews related to reports of non-compliance received through Vaya's Compliance Hotline.
• Collect, analyze and identify trends from audit and investigation results and/or findings.
• Assist in identifying areas of improvement within the organization and work with departments to develop internal plans of correction, as needed.
• Assist with external reviews and accreditation activities, as needed.
• Provider organizational oversight, storage, and maintenance of electronic documentation which may include records, letters, forms, presentations, and/or templates.
• Assist staff with maintaining compliance of organizational file storage, folder structures, and file/folder naming conventions.
• Assist the Office of Communication with documentation resource needs.
• Maintain policies and procedures as needed.
• Take lead on special projects for the organization as requested.
• Assist and work with the Delegation Oversight and Risk Management Team in the identification of potential organizational risks.
• Communicate clearly and professionally in all formats (email, telephone, virtual, Teams, facsimile, etc.) with Vaya staff, Department representatives and other external individuals, as needed.
• Participate in Vaya committees and/or workgroups as directed.
• Assist the Grievance and Incident Resolution Team by investigating member and provider grievances as needed.
• Assist in the preparation of and participate in hosting Vaya's annual Compliance Week event.
• Collaborate with the External Review Team and Accreditation Team with the collection of documentation and relevant policies for external reviews, as needed.

Other Duties as Assigned.

Note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

KNOWLEDGE, SKILLS & ABILITIES

• Strong organizational skills with attention to detail and the ability to multi-task.
• Highly effective oral and written communication skills are required, including strong presentation skills and proficiency in grammar, punctuation, and spelling. STRONG WRITING SKILLS ARE ESSENTIAL FOR THIS POSITION
• Strong project coordination and administration background with the ability to work with organizational leadership to collect information.
• Knowledge of policy and procedure drafting and editing with practical experience in applying that knowledge.
• Ability to identify areas of improvement or correction in a professional and constructive manner.
• Ability to complete tasks in a timely and accurate manner.
• Ability to work independently with little or no direction, demonstrate initiative, be goal-oriented, and function as a self-starter.
• Demonstrate strong attention to detail, extreme precision, and meticulous accuracy for all tasks.
• Ability to learn, interpret independently, and apply a variety of complex policies and procedures.
• Exceptional interpersonal skills, diplomacy and conflict resolution skills are essential.
• Excellent time management skills and the ability to manage competing priorities and projects.
• Ability to manage constant transformation and adapt to changing mandates from regulatory authorities as well as Vaya executive leadership
• Ability to maintain confidentiality.
• Ability to solve problems and provide practical, thorough, and creative solutions to work tasks and complex problems.
• Extensive knowledge and advanced proficiency in Adobe and Microsoft Office products (Word, Excel, Outlook, PowerPoint, Teams, Visio, etc.), including experience with graphs, charts, presentations, etc.
• Ability to research and understand multiple Electronic Records Systems.
• Experience in data collection and analysis and the ability to recognize trends is essential.

Preferred Knowledge, Skills and Abilities:

• Strong knowledge of state and federal laws, rules, regulations, contract requirements, and practices related to Vaya Health's operations in North Carolina is beneficial.
• Previous experience with regulatory bodies, including accreditation, with working knowledge of NCQA standards a plus.

EDUCATION & EXPERIENCE REQUIREMENTS

Bachelor's degree in Compliance Analytics, Government/Public Administration, Auditing, Investigations, Pre-law, or Healthcare Compliance related service field required. Master's degree preferred.

• A Bachelor's degree and at least three years' practical experience in performance improvement, quality management, compliance, auditing and investigation or policy development and maintenance.

OR

• A Master's degree in a healthcare related field and at least one (1) year practical experience in performance improvement, quality management, compliance, auditing and investigation or policy development, and maintenance.

Equivalent combination of education and experience will be considered, however a higher degree will not take the place of practical experience in its entirety.

Preferred work experience:

At least one year technical/professional writing, performance improvement, quality management, compliance, auditing and investigation or policy development, and maintenance in a healthcare setting (physical health and/or behavioral health)

Licensure/Certification:

PHYSICAL REQUIREMENTS

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists, and fingers.
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
• Mental concentration is required in all aspects of work.

RESIDENCY REQUIREMENT: The person in this position must reside in NC, SC, GA, TN, VA, MD, or FL. North Carolina residency preferred.

SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open Until Filled

APPLY: Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.

Vaya Health is an equal opportunity employer.