vynca - Compliance Specialist

• Compliance Program Support • 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. • Quality Program Support • 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. • Regulatory Monitoring & Risk Management • 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. • Auditing, Monitoring & Investigations • 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. • Training, Education & Communication • 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. • This is a critical role and we're looking to fill it as soon as possible • Vaccination Requirement: Employees in patient, client, or customer-facing roles must be vaccinated against influenza. Requests for religious or medical accommodations will be considered but may not always be approved. • Employment Eligibility: Compliance with federal law requires identity and work eligibility verification using E-Verify upon hire.