Contract Auditor

VNS Health; New York (NY); On-site; USD 70,000 - 88,000; Full time

Benefits offered by this job

Referral bonus

PTO & holidays

Health insurance

Retirement plan

Wellness programs

FSAs

Tuition reimbursement

Career growth

Internal mobility

Job summary

VNS Health in New York seeks an Audit Specialist to conduct regulatory, credentialing, and contractual compliance audits of SADC, CDPAS/FI, and LHCSA providers. You will review documents, assess adherence to NYS rules and VNS Health standards, and draft findings and corrective actions.

This role requires travel across Downstate NYC, up to 90%, and close collaboration with Network, Compliance, Quality, Operations, and Claims teams to drive improvements and regulatory readiness.

Qualifications

• Associate's Degree or equivalent work experience required.
• Minimum 3 years contract-related health care experience.
• Familiarity with Medicaid/Medicare compensation methodologies.
• Resides in Downstate NY preferred.
• Travel up to 90% required.

Responsibilities

• Conducts scheduled and targeted on-site compliance audits for SADC, CDPAS/FI, and LHCSA providers.
• Evaluates provider adherence to regulatory requirements, contractual obligations, credentialing standards, and VNS Health policies.
• Reviews provider documentation, operational processes, staffing qualifications, training records, and required regulatory materials.
• Develops audit findings, scoring summaries, corrective action requirements, and recommendations for improvement.
• Monitors provider corrective action plans and perform follow-up reviews to validate remediation.
• Maintains audit tracking, documentation, reporting, and audit calendars.
• Identifies trends, recurring deficiencies, and opportunities for provider education and process improvement.
• Collaborates with Network, Compliance, Quality, Operations, Claims, and other internal teams on provider performance concerns.
• Supports regulatory audits and special projects as assigned.
• Travels throughout Downstate NYC to conduct on-site audits, complaint investigations, and regulatory reviews; 90% travel.
• Communicates proactively and collaborate with internal departments to ensure regulatory alignment, operational efficiency, and effective resolution of compliance matters.
• Participates in special projects and performs other duties as assigned.

Skills

Regulatory compliance

Auditing

Travel up to 90%

Medicare/Medicaid knowledge

Education

Associate's degree or equivalent experience

Bachelor's degree in Business Administration/Finance/Accounting or related field preferred

Tools

Regulatory guidelines

Job description

Overview

Conducts regulatory, credentialing, and contractual compliance audits for designated Network providers, including Social Adult Day Cares (SADCs), Consumer Directed Personal Assistance Services (CDPAS)/Fiscal Intermediaries (FIs), and Licensed Home Care Service Agencies (LHCSAs). Evaluates provider compliance with New York State regulatory requirements and VNS Health contractual standards through on-site audits, documentation reviews, risk assessments, and follow-up corrective action monitoring. Partners with Network leadership and internal stakeholders to identify compliance risks, improve provider performance, support regulatory readiness, and ensure contracted agencies maintain operational standards necessary to deliver quality services to members. This position typically requires 1-3 days per week in the field, based on business and audit needs.

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Conducts scheduled and targeted on-site compliance audits for SADC, CDPAS/FI, and LHCSA providers.
• Evaluates provider adherence to regulatory requirements, contractual obligations, credentialing standards, and VNS Health policies.
• Reviews provider documentation, operational processes, staffing qualifications, training records, and required regulatory materials.
• Develops audit findings, scoring summaries, corrective action requirements, and recommendations for improvement.
• Monitors provider corrective action plans and perform follow-up reviews to validate remediation.
• Maintains audit tracking, documentation, reporting, and audit calendars.
• Identifies trends, recurring deficiencies, and opportunities for provider education and process improvement.
• Collaborates with Network, Compliance, Quality, Operations, Claims, and other internal teams on provider performance concerns.
• Supports regulatory audits and special projects as assigned.
• Travels throughout Downstate NYC to conduct on-site audits, complaint investigations, and regulatory reviews in order to meet oversight and compliance requirements. This role will require 90% travel.
• Communicates proactively and collaborate with internal departments to ensure regulatory alignment, operational efficiency, and effective resolution of compliance matters.
• Participates in special projects and performs other duties as assigned.

Qualifications

Education:
Associate's Degree or equivalent work experience required
Bachelor's Degree in Business Administration, Finance, Accounting or related field preferred
Work Experience:
Minimum 3 years contract-related experience in the health care field including, but not limited to, provider's office, managed care organization, or other health care or regulatory environment, or equivalent combination of relevant education and experience required
Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare required
Resides in Downstate NY preferred
Experience / knowledge of SADC's required
Compliance requirements (OSHA / ADA) required

Pay Range

USD $70,200.00 - USD $87,700.00 /Yr.

About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We're one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.