Vendor Compliance Program Manager - Jefferson Health Plan at Jefferson Health Plans

Job Details

The Vendor Compliance Program Manager is responsible for overseeing and ensuring regulatory compliance across all vendor-related activities and partnerships supporting Medicare, Medicaid, CHIP, and ACA lines of business. This role manages day-to-day compliance operations, including audit readiness, regulatory reporting, and monitoring efforts tied to vendor performance.
The Manager will lead internal and external audits, develop and implement corrective action plans, and coordinate compliance improvement strategies with vendor teams. Acting as the liaison between Compliance and vendor departments, this position facilitates regular compliance meetings, supports risk mitigation efforts, and ensures that policies and procedures align with current regulatory standards.
This role is integral to maintaining operational efficiency, promoting accountability, and supporting the organization’s broader compliance objectives through consistent oversight, education, and collaboration.

Job Description

Ensure Regulatory Compliance

• Track and maintain all Vendor compliance activities across all lines of business and work with units within the department to complete. Compliance activities include but are not limited to:
  • External day to day inquires
  • Internal/ External Audit Deliverables
  • Regulatory reporting
• Review department policies, procedures and desktop procedures to ensure they meet regulatory requirements.
   

Conduct Monitoring, Auditing and Improvement Action Plan Activities within Vendor Teams

• Conduct monitoring for all lines of business (Medicare, Medicaid, CHIP and ACA) according to departmental processes and workflows.
• Perform scheduled audits according to Compliance Work Plan
• Perform ad-hoc targeted regulatory audits as needed.
• Oversee the development, implementation and management of departmental improvement action plans initiated by internal and/or external audits by conducting root cause analysis, track progress, educate on audit errors and ensure timely completion of corrective measures.

 Audit & Meeting Management

• Provide leadership in audits and reviews by regulatory bodies.
  • Ensure accurate data collection and timely submission.
  • Compile audit findings and report to executive management in Vendor teams and internal committees as needed.
• Prepare Vendor teams for internal and/or external regulatory audits by reviewing previous audit material and results and ensuring that department is ready and available to meet the needs of active and upcoming audits.
• Serve as the Compliance liaison for facilitating monthly Compliance Vendor team’s meetings.

Risk Mitigation

• Research trends and identify areas that present potential risk to the Vendor departments.
• Utilize identified potential risks related to non-compliance to develop internal department improvement action plans to address deficiencies.

Support Organizational Strategy

• Assist in developing, producing, and conducting compliance training programs for staff to understand regulatory requirements.
   

Improve Efficiency

• Enhance operational efficiency by standardizing regulatory workflows.
• Support and deliver regulatory reporting and performance initiatives.

Education and Expereince:

• Bachelor’s degree in a related field such as Healthcare Administration & Business Administration
• 5–7 years of progressive experience in Healthcare compliance, Vendor oversight or third-party risk management, Regulatory affairs or audit functions, Managed care or insurance operations

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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