Compliance Partner (Remote)
: Job Details :

LOCATION: Remote - this is a home based, virtual position that operates within the hours of 8:30am-5:00pm on US Eastern Standard Time (EST). Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL. North Carolina residency preferred.GENERAL STATEMENT OF JOBVaya Health is a local political subdivision of the State of North Carolina that manages Medicaid and other publicly funded health care services in western North Carolina. Vaya's Compliance Department is comprised of four teams: External Review & Delegation Oversight, Privacy, Regulatory Compliance, and the Special Investigations Unit.The Compliance Partner reports to the Regulatory Compliance Director. This position is responsible for conducting internal audits and investigations, overseeing the implementation of internal corrective action plans, ensuring compliance with accreditation activities, organizational Policy and Document management, and related duties. The Compliance Partner plays an integral role in assisting the Regulatory Compliance Director by ensuring compliance with all accreditation, statutory and regulatory requirements. The Compliance Partner will assist in monitoring Tailored Plan post-implementation activities to ensure maintenance of all corrective actions implemented and maintain a working relationship with various cross-functional teams, departments and committees to ensure business processes are monitored, verified and corrected as needed.ESSENTIAL JOB FUNCTIONSRegulatory, Contractual and Accreditation Compliance:Conduct internal regulatory compliance audits.Conduct internal investigations.Develop audit tools around accreditation, statutory and regulatory requirements and assist in monitoring internal performance standards through internal audits.Develop internal investigation plans and conduct applicable interviews.Collect, analyze and identify trends from audit and investigation results or findings.Assist in identifying areas of improvement within the organization and working with departments to develop internal corrective action plans as needed.Assist with accreditation activities as assigned.Participate in the maintenance of policies and procedures as needed.Participate in the maintenance of all Vaya documents including, but not limited to, forms, templates, and letters as needed.Work with departments and Committees in developing, implementing, and completing internal audit plans (self-evaluations) to ensure compliance with standards and/or regulations.Lead special projects for the organization as requested.Assist in identifying potential organizational risks.Other Duties as Assigned:Participation in Vaya Committees and/or workgroups as directed.Assist and participate in the organization and hosting of Vaya's annual Compliance Week event.Assist with collection of documentation for external reviews.Assist in the development of corrective action plans required by regulatory or accreditation bodies in response to identified areas of non-compliance.Assist the External Review & Delegation Oversight Team as needed.Other duties as assigned.KNOWLEDGE, SKILL & ABILITIES REQUIREDAttention to detail, strong writing skills, good judgment, and discretion on all aspects of work are extremely critical to being successful in this position.Strong team player who understands the role of the position, respects boundaries, welcomes collaboration, remains respectful, maintains a positive attitude and demonstrates the ability to work harmoniously with a diverse workforce.Solution-focused and committed to self-accountability.Flexible worker who readily accepts assigned tasks, manages unfamiliar situations, and searches for every opportunity to help the team.Actively contributes to the Business Integrity Department in order to complete tasks, meet goals and manage projects.Effective communicator who respects others' ideas and practices active listening to solve problems, improve processes and retain information such as instructions, procedures and expectations.Excellent time management skills, including the ability to manage competing priorities and to complete tasks in a timely and accurate manner.Highly productive and motivated individual who takes pride in a job well done.Strong attention to detail and extreme precision and accuracy.Ability to work collaboratively with individuals at all levels and with varying backgrounds both within and outside of Vaya and build strong working relationships.Ability to work independently with little or no direction, demonstrate initiative, and function as a self-starter.Strong organizational skills with the ability to multi-task.Ability to manage constant transformation and adapt to changing mandates from regulatory authorities as well as Vaya executive leadership.Ability to maintain the confidentiality of sensitive information in accordance with applicable laws, policies, and rules.Ability to problem-solve and provide practical, thorough, and creative solutions to work tasks.Ability to learn, interpret independently, and apply a variety of complex policies and procedures.Good working knowledge and proficiency in Adobe and Microsoft Office 365 products (Word, Excel, Outlook, PowerPoint, Teams, Visio, etc.). Must be able to format and manipulate Excel documents for printing and presentation as well as Word and/or PowerPoint documents for distribution, printing, and presentation. Must be able to schedule meetings and tasks using Outlook. Must be able to schedule and manage virtual Teams meetings.Thorough knowledge of standard office practices, procedures, and office assistance techniques.Previous experience with accrediting bodies.Excellent negotiation, interpersonal and customer service skills.Ability to communicate in a tactful and articulate manner while representing the interests of Vaya in the most professional manner possible.Excellent oral and written communication skills, including thorough knowledge and excellent skills in English grammar, punctuation, and spelling and knowledge of health literacy principles. STRONG WRITING SKILLS ARE ESSENTIAL FOR THIS POSITION.Ability to conduct data analysis and recognize trends is essential.Ability to effectively communicate trends within Vaya to address potentially serious issues is required.Ability to work remotely (from home) with little supervision and function as a self-starter.Thorough knowledge of how to use standard office equipment, including printers, scanners, and fax machines.Ability to work independently is essential.Ability to research multiple Electronic Records Systems.Ability to understand claims data.Ability to understand both physical and behavioral health diagnoses.Ability to synthesize information gathered in the grievance process to write a succinct resolution letter.Ability to direct and interact with Incident Specialists while performing grievance resolution lead duties in a respectful manner.Ability to use critical thinking skills, work independently with little or no direction, demonstrate initiative, and function as a self-starter.Ability to develop practical, thorough, and creative solutions to complex problems.Experience in data collection and analysis.Advanced proficiency/ skills in Microsoft Excel that include pivot tables, graphs, charts, etc. and ability to format and manipulate Excel documents for printing and presentation.Preferred Knowledge, Skills and Abilities:Knowledge of North Carolina's public behavioral health and I/DD system, including Vaya providers, services, and stakeholders, preferred.Experience in Managed Care a plus.Experience with Medicaid a plus.Familiarity with SharePoint and Navex software products (PolicyTech, EthicsPoint) a plus.Working knowledge of NCQA standards is a plus.QUALIFICATIONS & EDUCATION REQUIREMENTSBachelor's degree in a Healthcare related field, Business, English, Human Resources, Psychology or other relevant field. Master's degree preferred.A Bachelor's degree and at least three (3) years' practical experience in technical/business writing, performance improvement, quality management, compliance, auditing and investigation or policy development and maintenance in a healthcare setting (physical health and/or behavioral health).A Master's degree in a healthcare related field and at least one (1) year practical experience in technical/business writing, performance improvement, quality management, compliance, auditing and investigation or policy development, and maintenance in a healthcare setting (physical health and/or behavioral health).Equivalent combination of education and experience will be considered, however a higher degree will not take the place of practical experience in its entirety.Licensure/Certification Required:CLEAR Certification preferred.PHYSICAL REQUIREMENTSClose 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 FilledAPPLY: Vaya Health accepts online applications in our Career Center, please visit Health is an equal opportunity employer.#J-18808-Ljbffr