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Committed to empowering individuals, their loved ones, and their care teams with solutions delivered in their homes.
Compliance Specialist
Location
United States
Posted
103 days ago
Salary
$85K - $105K / year
Seniority
Mid Level
Job Description
Compliance Specialist
Vynca
• Support the design, implementation, and ongoing maintenance of the organization’s healthcare compliance program in alignment with OIG and DOJ Compliance Program Guidance. • Assist in operationalizing the seven elements of an effective compliance program, including policies and procedures, training, monitoring, auditing, reporting, and enforcement. • Serve as a key resource to internal stakeholders on compliance-related questions and issues, providing guidance to translate regulatory requirements into actionable organizational practices. • Support compliance and quality oversight for Enhanced Care Management (ECM) and Palliative Care programs in alignment with federal, state, and payer requirements. • Monitor regulatory and contractual requirements while tracking evolving guidance impacting program operations, care delivery, and documentation standards. • Conduct audits, monitoring, and QAPI activities, including metric tracking, trend analysis, and support for corrective action plans. • Collaborate cross-functionally to address compliance risks, support audit readiness, and integrate quality and compliance standards into program workflows. • Monitor federal and state healthcare laws and regulations, including but not limited to Anti-Kickback Statute, Stark Law, False Claims Act, HIPAA, and applicable state healthcare regulations. • Track DOJ and OIG enforcement actions, advisory opinions, special fraud alerts, and compliance guidance, and assess applicability to organizational operations. • Conduct compliance risk assessments and help identify, document, and address compliance risks, including fraud, waste, and abuse (FWA), enforcement trends, government oversight, and internal audits. • Support regulatory change management by tracking new or updated laws, regulations, and enforcement trends, including monitoring requirements for potential new markets as the organization expands. • Assist with compliance audits, monitoring activities, and reviews to assess adherence to internal policies and regulatory requirements. • Support internal investigations related to potential compliance concerns, including documentation, issue tracking, and corrective action plans. • Coordinate responses to compliance inquiries, audits, and regulatory requests, as directed by Compliance Leadership. • Maintain investigation and audit documentation in accordance with DOJ and OIG standards and expectations. • Assist in developing and delivering compliance training and education programs for employees, contractors, and leadership. • Promote awareness of compliance reporting mechanisms and non-retaliation standards. • Draft compliance communications, guidance documents, and policy updates, and support implementation of compliance guidance into day-to-day operations. • Maintain organized, audit-ready records. • Collaborate with internal departments to streamline workflows and improve regulatory preparedness. • Stay informed on state and federal regulatory requirements. • Support ad-hoc compliance and quality initiatives, including policy updates, audits, and corrective action implementation, as needed.
Job Requirements
- Bachelor’s degree in Healthcare Administration, Compliance, Legal Studies, Business, or a related field, or equivalent healthcare compliance experience.
- 2+ years of experience in healthcare compliance, regulatory affairs, audit, or a related role.
- Working knowledge of healthcare compliance laws and regulations at the federal and state level.
- Familiarity with healthcare enforcement trends and OIG/DOJ Compliance Program Guidance and enforcement priorities.
- Experience supporting quality assurance and performance improvement (QAPI) initiatives, audits, or quality monitoring activities.
- Strong analytical, organizational, and documentation skills.
- Strong understanding of healthcare compliance and regulatory frameworks.
- Ability to analyze regulations and translate them into practical guidance.
- High ethical standards and sound judgment.
- Excellent written and verbal communication skills.
- Detail-oriented with strong follow-through.
- Ability to assess operational compliance gaps and make risk-based decisions.
- Certification in Healthcare Compliance (CHC) or similar compliance certification (Preferred).
- Experience supporting compliance audits, investigations, or regulatory examinations (Preferred).
- Knowledge of CMS regulations and reimbursement compliance (Preferred).
- Experience with Enhanced Care Management (ECM), Palliative Care programs, or similar care management models within Medicaid or managed care environments (Preferred).
Benefits
- medical, dental, and vision insurance
- income protection benefits
- flexible PTO
- company holidays
- 401k
- access to other wellness benefits
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