Manager, Compliance & Audits_Provider Network

Versant Health; United States; On-site; USD 80,000 - 85,000; Full time

Job summary

An established industry player is seeking a dynamic Manager for Compliance and Audits within their Provider Network. This pivotal role involves ensuring adherence to regulatory standards, managing audits, and leading corrective actions. The ideal candidate will possess extensive knowledge of healthcare regulations and demonstrate strong project management skills. With a commitment to fostering a collaborative environment, this position offers opportunities for professional growth and development. Join a forward-thinking company dedicated to making a meaningful impact in the healthcare sector, where your expertise will contribute to enhancing the quality of care for members nationwide.

Benefits

Health Insurance

Dental Insurance

Tuition Reimbursement

401(k) with Company Match

Pet Insurance

No-Cost Vision Insurance

Qualifications

• 5-7 years in provider network management and compliance.
• Expertise in healthcare regulations and audit processes.

Responsibilities

• Oversee compliance with federal and state regulations.
• Manage audits and coordinate corrective actions.
• Generate compliance reports for senior management.

Skills

Regulatory Compliance

Audit Management

Project Management

Healthcare Regulations

Communication Skills

Data Analysis

Education

Bachelor's degree in business or healthcare administration

Tools

Compliance Management Tools

Job description

Manager, Compliance & Audits_Provider Network

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Manager, Compliance & Audits_Provider Network

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Manager, Compliance & Audits

Manager, Compliance & Audits_Provider Network

Who are we?

Versant Health is one of the nation’s leading administrators of managed vision care, serving millions of our clients’ members nationwide. We are driven by our mission to help members enjoy the wonders of sight through healthy eyes and vision.

As a Versant Health associate, you can enjoy a comprehensive Total Rewards package, which includes health and dental insurance, tuition reimbursement, 401(k) with company match, pet insurance, no-cost-to-you vision insurance for you and your qualified dependents. We are also invested in your success. There are many opportunities for advancement and development throughout all stages of your career with us.

See how you can make a difference with the support of strong leadership and a team environment.

See Everything, Be Anything.

What are we looking for?

Versant Health is seeking an experienced and dynamic Manager, Compliance, and Audits_ Provider Network to oversee and lead provider network regulatory activities and audits. This key role will ensure that the provider network adheres to all federal, state, accreditation, and regulatory requirements. You will be responsible for managing audits, corrective actions, regulatory compliance, and reporting while working closely with internal and external stakeholders. This position requires strategic oversight, audit execution, and close collaboration with the Network Operations team, while being flexible with less than 25% travel annually.

Where you will have an impact

Regulatory Compliance & Audits

Oversee and manage compliance with all federal, state, and accreditation requirements related to provider networks, including delegated audits, corrective actions, and reporting.

Manage and coordinate SOC 1 Control Audits, including audit performance, measurements, remediations, and reporting to leadership.

Directly responsible for leading health plan and client audits, presenting audit outcomes, and managing corrective action plans (CAPs).

Policy And Procedure Management

Lead the creation, review, and maintenance of policies and procedures for Network Development activities to ensure alignment with federal, state, and accreditation requirements.

Work closely with the Network Development team to implement corrective actions and manage the necessary updates to operational policies and procedures.

Project And Stakeholder Management

Partner with internal teams, including Regulatory Compliance, Claims, Call Centers, Utilization Management, and other business functions to drive the implementation of regulatory changes.

Guide the organization through regulatory compliance processes, ensuring that new regulations are understood and properly implemented within the network’s operations.

Facilitate cross-functional collaboration to determine scope and resources required to implement changes, ensuring alignment with organizational goals.

Support the development of implementation plans for regulatory changes, ensuring policies, processes, and controls meet compliance standards.

Audit Reporting And Analytics

Generate and distribute compliance reports and audit findings to senior management. Provide trend analysis and recommendations for continuous improvement.

Assist in reporting to external auditors and regulatory bodies, ensuring timely and accurate submission of required documentation.

Leadership & Team Development

Provide training and guidance to internal teams on regulatory changes, compliance requirements, and audit processes.

Act as a subject matter expert, offering insights and support to Network Development and Regulatory Compliance teams.

What’s necessary to do the job?

Bachelor’s degree in business, healthcare administration, or a related field

Minimum of 5-7 years of experience in provider network management, compliance, audits, or regulatory affairs, with specific experience in healthcare or insurance sectors.

Deep knowledge of healthcare regulations, including HIPAA, CMS guidelines, and other federal and state laws impacting provider networks.

Experience conducting audits related to provider networks and managing corrective actions for compliance.

Proven expertise in managing SOC 1 control audits and delegations in health plans and client oversight audits.

Advanced knowledge of regulatory requirements and their impact on provider networks, with a focus on implementing compliance initiatives across multiple functional areas.

Strong project management skills, with experience in handling complex regulatory projects and working cross-functionally to ensure successful implementation.

Excellent communication and presentation skills, with the ability to interact with senior leadership, auditors, and external stakeholders.

Ability to generate reports, analyze trends, and make data-driven recommendations.

Detail-oriented with strong organizational and problem-solving abilities.

Certification in Healthcare Compliance (CHC) or related certifications is a plus.

Experience with Versant Health or similar healthcare organizations is beneficial.

Familiarity with compliance management tools and systems for regulatory oversight and audits.

HIPAA & Security Requirements

All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.

Versant Health will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process.

Versant Health is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at Versant Health without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.

The wage range for applicants for this position is ($80,000.00 to $85,000.00)

All incentives and benefits are subject to the applicable plan terms.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Legal

• Industries

  Insurance

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