AMVETS Jobs

This job was posted by https://idahoworks.gov : For more information, please see: https://idahoworks.gov/jobs/2358219

Vendor Audit and Compliance Specialist

Work from home within Oregon, Washington, Idaho or Utah

Build a career with purpose. Join our

Cause

to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia\'s dedicated team of Vendor Audit and Compliance Specialists are living our mission to make health care easier and lives better. As a member of the Quality team, our Vendor Audit and Compliance Specialist oversees delegated business functions across multiple product lines, ensuring third-party vendors meet organizational standards and regulatory requirements. This role conducts pre-delegation assessments, ongoing oversight, and audits of delegated entities, focusing on their operational processes, documentation, and reporting capabilities. The position involves evaluating clinical care quality, utilization management, and case management while collaborating with clinical and administrative professionals. Key interactions include internal management, vendors, government officials, and accrediting agencies. The specialist must effectively analyze data, resolve complex compliance issues, and ensure all delegated activities align with regulatory and accreditation guidelines - all in service of creating a person-focused health care experience.

Are you a detail-oriented professional who thrives on ensuring operational excellence and compliance? Do you excel at building relationships while maintaining strict regulatory standards? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

• Bachelor\'s degree and 6 years of progressive experience in health care administration, as a project leader or project support or a related experience, or an equivalent combination and education is required.
• At least three years of experience must be in coordination and oversight of health-care related delegation activities and contracting.
• Master\'s degree is preferred.

Skills and Attributes:

• Possesses comprehensive understanding of managed care systems and their core principles
• Can effectively implement and manage delegation programs that align with company-wide initiatives and strategic objectives
• Excels in project-related tasks including creating reports, maintaining documentation, writing policies, and analyzing data - with a knack for turning complex statistics into clear corporate communications
• Well-versed in healthcare regulatory requirements and quality benchmarks, including Medicare standards, URAC certification, and NCQA guidelines
• Skilled at evaluating clinical service needs within delegated contracts and determining areas for growth
• Expert at juggling multiple projects and meeting deadlines through strong project management capabilities
• Communicates effectively with external partners and delegated entities, maintaining clear channels of both written and verbal communication
• Demonstrates finesse in navigating complex situations, using diplomatic approaches to negotiate solutions and build consensus
• Builds strong relationships across all organizational levels through excellent communication skills and interpersonal abilities
• Shows strong analytical capabilities - can identify challenges, craft practical solutions, and successfully implement action plans

What You Will Do at Cambia:

• Serves as the delegation Subject Matter Expert (SME), managing corporate-level projects and implementing administrative policies while providing team leadership and resource support.
• Develops and maintains comprehensive oversight policies for delegated functions, including credentialing, ut lization management, case management, appeals, and claims processing, ensuring compliance with regulatory and accreditation requirements.
• Conducts thorough delegation oversight reviews, either on-site or virtually, utilizing standardized audit tools to evaluate performance and prepare detailed reports of findings.
• Manages the corrective action process by working with delegates to develop and implement improvement plans, monitoring progress, and escalating unresolved issues when necessary.
• Leads cross-divisional committees and develops comprehensive reports on delegation activities for leadership, while managing delegation-related reporting systems and defining business requirements.
• Coordinates effectively with internal departments and external delegates to schedule reviews, maintain communication channels, and ensure timely completion of all delegation-related activities.
• Responds to internal and external requests for proposals (RFPs) and information while serving as a key liaison between management levels and maintaining oversight of delegated contracts.

#LI-Remote

The expected hiring range for a Vendor Audit and Compliance Specialist is \$91,800 - \$124,200 depending on skills