CareSource
Vendor Governance Specialist (Compliance/Oversight Experience Required)
CareSource, Dayton, Ohio, United States, 45402
Job Summary:
The Vendor Governance Specialist is responsible for managing regulatory submissions for contracts including completing necessary documents and tracking state approval.
This position also assists with obtaining updated certificates of insurance from vendors, conducting financial reviews, and assess the risk of CareSource doing business with vendors.
Essential Functions:
Complete documents or portal submissions required for regulatory submissions of vendor contracts
Monitors contract submissions and state approvals
Oversee state submission reporting
Assist with state submitted expiring contracts to ensure compliance
Works closely with compliance leadership and plan compliance officers to interpret regulatory guidance to provide to strategic sourcing regarding contract submission requirements.
Work closely with legal and business owners from all areas to ensure that all required documentation of state submissions are provided with contract submissions.
Collaborate with plan compliance officers on new requirements for contract submissions and help to implement new requirements when applicable
Responsible for collaborating with state plan compliance officers or compliance leadership to obtain guidance on state contract submission requirements of new markets, through growth or acquisition, as timely as possible.
Coordinate state inquiries and responses
Assist in obtaining updated Certificate of Insurance from Vendors that have expired
Perform financial reviews of Vendor for viability
Perform assessments of vendor risk, develop mitigation plan and partner with internal stakeholders to assign monitoring responsibility Performs any other job related duties as requested.
Education and Experience:
Bachelor's degree in business management, science, health administration, health policy or related discipline required Equivalent years of relevant work experience may be accepted in lieu of required education Three (3) years in vendor or provider compliance or oversight, and/ or contract management required
Experience in the healthcare industry, preferably within a managed care organization preferred Competencies, Knowledge and Skills:
Excellent written and research skills
Strong analytical skills to gather, organize and summarize information
Exhibit a high degree of professionalism
Strong project management skills with ability to handle multiple projects within time constraints
Strong organization skills and attention to detail
Knowledge of Federal, State, NCQA and standards preferred
Highly motivated individual with the ability to work independently in a detailed oriented environment Licensure and Certification:
Certified in Healthcare Compliance (CHC) and Certified Provider Credentialing Specialist (CPCS) preferred Working Conditions:
General office environment; may be required to sit or stand for extended periods of time Travel is not typically required Compensation Range: $61,500.00 - $98,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type: Salary Competencies: - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-SD1
The Vendor Governance Specialist is responsible for managing regulatory submissions for contracts including completing necessary documents and tracking state approval.
This position also assists with obtaining updated certificates of insurance from vendors, conducting financial reviews, and assess the risk of CareSource doing business with vendors.
Essential Functions:
Complete documents or portal submissions required for regulatory submissions of vendor contracts
Monitors contract submissions and state approvals
Oversee state submission reporting
Assist with state submitted expiring contracts to ensure compliance
Works closely with compliance leadership and plan compliance officers to interpret regulatory guidance to provide to strategic sourcing regarding contract submission requirements.
Work closely with legal and business owners from all areas to ensure that all required documentation of state submissions are provided with contract submissions.
Collaborate with plan compliance officers on new requirements for contract submissions and help to implement new requirements when applicable
Responsible for collaborating with state plan compliance officers or compliance leadership to obtain guidance on state contract submission requirements of new markets, through growth or acquisition, as timely as possible.
Coordinate state inquiries and responses
Assist in obtaining updated Certificate of Insurance from Vendors that have expired
Perform financial reviews of Vendor for viability
Perform assessments of vendor risk, develop mitigation plan and partner with internal stakeholders to assign monitoring responsibility Performs any other job related duties as requested.
Education and Experience:
Bachelor's degree in business management, science, health administration, health policy or related discipline required Equivalent years of relevant work experience may be accepted in lieu of required education Three (3) years in vendor or provider compliance or oversight, and/ or contract management required
Experience in the healthcare industry, preferably within a managed care organization preferred Competencies, Knowledge and Skills:
Excellent written and research skills
Strong analytical skills to gather, organize and summarize information
Exhibit a high degree of professionalism
Strong project management skills with ability to handle multiple projects within time constraints
Strong organization skills and attention to detail
Knowledge of Federal, State, NCQA and standards preferred
Highly motivated individual with the ability to work independently in a detailed oriented environment Licensure and Certification:
Certified in Healthcare Compliance (CHC) and Certified Provider Credentialing Specialist (CPCS) preferred Working Conditions:
General office environment; may be required to sit or stand for extended periods of time Travel is not typically required Compensation Range: $61,500.00 - $98,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type: Salary Competencies: - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-SD1