Senior Manager, Compliance Audit and Monitoring

Summary

Join Oscar as a Senior Manager, Compliance Audit and Monitoring and lead the enterprise's compliance programs. You will oversee delegation oversight, develop and manage compliance programs aligning with healthcare regulations, and lead a team of associates. Responsibilities include developing risk-based audit plans, conducting training, ensuring regulatory compliance (HIPAA, Medicare, Medicaid), and providing guidance to departmental leaders. You will report to the Director, Regulatory Audit & Reporting and work remotely or in a blended work environment. The role requires a Bachelor's degree or equivalent experience, 6+ years of payer experience and team leadership, and 4+ years in healthcare compliance. Compensation includes a competitive salary, benefits, unlimited vacation, and annual performance bonuses.

Requirements

• Bachelor's degree or commensurate work experience
• 6+ years working with payer experience
• 6+ years in leading direct reports and teams
• 4+ years experience working in health care or related field with Procedures
• 4+ years driving compliance with regulatory and accreditation audit/policy requirements
• 4+ years Experience working with regulation and translating into operational procedures
• 4+ years Experience managing several critical, external facing, deliverables simultaneously
• 4+ years Experience in implementation, program building, and maintenance

Responsibilities

• Strategize and lead delegation oversight and internal compliance activities with all partners
• Develop and implement a risk-based audit and monitoring plan for the healthcare organization
• Manage audit tools and conduct training to impart knowledge to staff and organization
• Ensure delegate and team adherence to contractual, regulatory, and accreditation requirements
• Lead the compliance audit and monitoring team, providing guidance and direction to ensure successful execution of audit plans and risks are identified and mitigated
• Ensure compliance with healthcare regulations, including HIPAA, Medicare, and Medicaid regulations
• Develop relationships with departmental leaders to understand business operations, identify areas of risk, and provide guidance on internal control design and implementation
• Evaluate the effectiveness of existing controls and develop risk assessment models to focus on, and prioritize, high-risk areas
• Establish key performance indicators (KPIs) for delegated entities and internal processes
• Approve audit and compliance monitoring reports, ensuring the quality of the audit findings and conclusions
• Implement and monitor corrective action plans for areas of non-compliance
• Provide regular updates to executive management and the Board of Directors on compliance audit and monitoring activities and findings
• Oversee the execution of internal and delegate audits and ensure timely audit planning and completion
• Provide strategic guidance and direction to departmental teams on compliance matters
• Delegate tasks to departmental leads to ensure timely compliance actions
• Establish and maintain compliance policies, procedures, and controls in alignment with regulatory requirements
• Compliance with all applicable laws and regulation
• Other duties as assigned

Preferred Qualifications

• Certification in Healthcare Compliance (CHC), Certified Compliance and Ethics Professional CCEP, or similar
• Fluency with State DOI audit and/or reporting obligations
• State DOI audit management experience
• Experience in a startup and/or health tech environment
• Experience in a TPA setting

Benefits

• Medical, dental, and vision benefits
• 11 paid holidays
• Paid sick time
• Paid parental leave
• 401(k) plan participation
• Life and disability insurance
• Paid wellness time and reimbursements
• Annual performance bonuses
• Unlimited vacation program