Senior Network Regulatory Specialist

Ensure client contracts are aligned with Provider Network Development policies and current regulatory requirements

Provide oversight for research and provide documentation for client and regulatory agency audits related to the Provider Network

Manage the NCQA Credentialing Accreditation process

Responsible for Provider Policy Management and ensure they comply with Client/Agency Audit CAPs and/or regulatory compliance updates

Provide oversight for the implementation of federal and state regulatory requirements as they relate to our network operations

Actively participate in compliance investigations and corrective action plans

Document compliance activities and track and report on all assigned activities

Participate in the development and execution of the annual Provider Network compliance work plan and related documents

Assist with the development, distribution, implementation and tracking of compliance forms, documents, policies and training materials in support of Provider Network compliance

Develop and maintain a working knowledge of relevant laws, rules, and regulations governing the Provider Network

Research Provider Network compliance topics as requested. Recommend proposed actions based on research results

Maintain timely communication with the Provider Network Manager on compliance concerns that have been reported and/or observed

Deliver exceptional customer service to internal business partners while balancing multiple competing interests and projects or considerable complexity

Other duties as assigned as necessary which promotes and maintains Provider Network compliance

Job Specifications

Typically has the following skills or abilities:

Bachelor's Degree in Business or related field or equivalent experience

Minimum of six years of experience and expertise in contributing, implementing and leading compliance programs in healthcare organizations

Experienced in Managed Care Compliance

Expert level of knowledge of state and federal health care statutes, regulations, and policies

Demonstrated organization, facilitation, communication, and presentation skills

Ability to act quickly and efficiently in emergent situations

Exceptional analytical, critical, creative thinking and project management skills to develop, and implement policies

Professional level written and verbal communication skills

Ability to assist in effectively communicating with policymakers, stakeholders, regulators and executives both orally and in writing

Ability to assess risk and design mechanisms to mitigate risk

Demonstrated ability to problem-solve, prioritize work, meet deadlines, and provide independent strategic direction/decision making

Excellent interpersonal skills

Ability to work with minimal direction/supervision; work with multiple tasks, challenging situations and meet deadlines

Ability to handle confidential information

Ability to regularly exercise discretion and independent judgment in the performance of his/her job duties

#LI-VISIONCARE

Compensation range for the role is listed below. Applicable salary ranges may differ across markets. Actual pay will be determined based on experience and other job-related factors permitted by law. As a part of the compensation package, this role may include eligible bonuses and commissions. For more information regarding VSP Vision benefits, please click here.

Unincorporated LA County Residents: Qualified Applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act, and any other similar laws.

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