Health Plan Compliance Auditor

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Assist with compliance initiatives for Oak Street Health’s internal care management and utilization management teams.

• Collaborate with operational leadership to execute and oversee ongoing quality enhancement efforts.

• Direct external compliance and accreditation survey processes.

• Organize compliance activities by leveraging program knowledge and analytical capabilities.

• Ensure adherence to CMS, contractual, accreditation, federal, state, and business regulations.

• Create, implement, and uphold policies and procedures.

• Design and execute auditing and monitoring tools for staff and program evaluations.

• Work in partnership with payers and serve as a subject matter expert on compliance matters.

• Contribute to reports for both internal and external leadership.

• Analyze auditing outcomes, trends, processes, and key performance indicators.

• Suggest process enhancements and interventions and assist with their implementation.

• Develop and update training materials based on quality assurance results.

• Formulate Corrective Action Plans and Performance Improvement Plans.

• Oversee operational responses and maintain ongoing compliance.

• Consistently adhere to HIPAA regulations, professional conduct, and ethical standards.

• Perform additional assigned responsibilities.

⛳️ Requirements

• Bachelor’s degree in Healthcare Administration, Compliance, a related field, or equivalent experience.

• 1-2 years of compliance experience related to care management requirements, utilization management requirements, auditing, reporting processes, action plans, and compliance training preferred.

• Strong comprehension of healthcare laws, NCQA standards, and Medicare Part C regulatory compliance in a managed care organization or hospital healthcare system setting.

• Experience collaborating with regulators on compliance audits.

• Ability to work both independently and as part of a team.

• Proven experience in fostering strong teamwork and collaborative communication.

• Capacity to perform under pressure with multiple deadlines and priorities.

• Excellent problem-solving, critical thinking, and organizational abilities.

• US work authorization.

• Commitment to the values of “Being Oaky.”

🏝️ Benefits

• Paid vacation and sick leave.

• 401K match options for retirement investment.

• Health insurance including vision and dental benefits.

• Opportunities for leadership development.

• Continuing education stipends.

• New centers and flexible work environments.

• Opportunities for significant responsibility and rapid advancement.

• Coverage for medical, dental, and vision.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.