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 requiredEquivalent years of relevant work experience may be accepted in lieu of required educationThree (3) years in vendor or provider compliance or oversight, and / or contract management requiredExperience in the healthcare industry, preferably within a managed care organization preferredCompetencies, Knowledge and Skills :
Excellent written and research skillsStrong analytical skills to gather, organize and summarize informationExhibit a high degree of professionalismStrong project management skills with ability to handle multiple projects within time constraintsStrong organization skills and attention to detailKnowledge of Federal, State, NCQA and standards preferredHighly motivated individual with the ability to work independently in a detailed oriented environmentLicensure and Certification :
Certified in Healthcare Compliance (CHC) and Certified Provider Credentialing Specialist (CPCS) preferredWorking Conditions :
General office environment; may be required to sit or stand for extended periods of timeTravel is not typically requiredCompensation 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 CultureCultivate PartnershipsDevelop Self and OthersDrive ExecutionInfluence OthersPursue Personal ExcellenceUnderstand the BusinessThis 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.
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