Senior Network Regulatory Specialist
Ensure our Provider Network meets regulatory, accreditation and contractual requirements and manage Provider Network compliance activities including Client Contract Reviews, RFP, Audits and NCQA Accreditation. Assist in the development and implementation of all facets of Provider Network compliance components, including but not limited to compliance training, monitoring and oversight of activities in support of Provider Network compliance, and investigation of compliance concerns.
Ensure client contracts are aligned with Provider Network Development policies and current regulatory requirements
Provide oversight for research and provide documentation for client and regulatory agency audits related to the Provider Network
Manage the NCQA Credentialing Accreditation process
Responsible for Provider Policy Management and ensure they comply with Client/Agency Audit CAPs and/or regulatory compliance updates
Provide oversight for the implementation of federal and state regulatory requirements as they relate to our network operations
Actively participate in compliance investigations and corrective action plans
Document compliance activities and track and report on all assigned activities
Participate in the development and execution of the annual Provider Network compliance work plan and related documents
Assist with the development, distribution, implementation and tracking of compliance forms, documents, policies and training materials in support of Provider Network compliance
Develop and maintain a working knowledge of relevant laws, rules, and regulations governing the Provider Network
Research Provider Network compliance topics as requested. Recommend proposed actions based on research results
Maintain timely communication with the Provider Network Manager 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 Provider Network compliance
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
#LI-VISIONCARE
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: $84,000.00 - $141,750.00
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, 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.
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Senior Network Regulatory Specialist
Ensure our Provider Network meets regulatory, accreditation and contractual requirements and manage Provider Network compliance activities including Client Contract Reviews, RFP, Audits and NCQA Accreditation. Assist in the development and implementation of all facets of Provider Network compliance components, including but not limited to compliance training, monitoring and oversight of activities in support of Provider Network compliance, and investigation of compliance concerns.
Ensure client contracts are aligned with Provider Network Development policies and current regulatory requirements
Provide oversight for research and provide documentation for client and regulatory agency audits related to the Provider Network
Manage the NCQA Credentialing Accreditation process
Responsible for Provider Policy Management and ensure they comply with Client/Agency Audit CAPs and/or regulatory compliance updates
Provide oversight for the implementation of federal and state regulatory requirements as they relate to our network operations
Actively participate in compliance investigations and corrective action plans
Document compliance activities and track and report on all assigned activities
Participate in the development and execution of the annual Provider Network compliance work plan and related documents
Assist with the development, distribution, implementation and tracking of compliance forms, documents, policies and training materials in support of Provider Network compliance
Develop and maintain a working knowledge of relevant laws, rules, and regulations governing the Provider Network
Research Provider Network compliance topics as requested. Recommend proposed actions based on research results
Maintain timely communication with the Provider Network Manager 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 Provider Network compliance
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
#LI-VISIONCARE
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: $84,000.00 - $141,750.00
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, 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.