CredSimple is building a healthcare technology company that serves the $10B niche of provider network management. We’re looking to grow our team with world-class talent who are not only motivated to carry out their specific roles but also help build an organization that continues to be a great place to work as we scale.

We sell to clients that span the healthcare spectrum from tech-savvy healthcare startups to 100-year-old, Fortune 500 health insurance companies. We’re solving very real and challenging problems in the healthcare industry. 

We’re committed to equal opportunity in our quest to hire and retain top talent. We believe in supporting our people in both personal and professional growth goals and pay attention to goals, celebrate milestones, and encourage you to learn continuously. We love working with self-starters, doers, collaborators and the insanely motivated.

We are looking for an experienced Compliance Manager based in New York City. You’ll join a talented and passionate team who enjoys working with our clients, solving tough problems, and improving the healthcare industry.


The Role

The mission of the Compliance team is to ensure CredSimple’s ongoing credentialing compliance with all applicable State and Federal regulations, and satisfy audit requests from regulators, clients, or prospects. Your mission specifically is to work closely with the Director of Compliance, other Compliance team members and key internal stakeholders to keep CredSimple compliant, ensure product & service is delivered with the highest quality of compliance to our clients, demonstrate leadership, and make compliance easy for our clients. 

The outcomes we’re looking for

  1. Assist in ensuring that CredSimple remains in continuous compliance with all NCQA guidelines, and passes all NCQA audits with the highest marks (100% of NCQA elements passed with >99% on each element)
    1. Maintains internal compliance documentation and standard operating procedures
    2. Helps to implement any required adjustment or corrective action across the organization
  2. Assist with the ongoing internal compliance program in order to ensure CredSimple’s process and procedures comply with State, Federal, and non-governmental/industry regulatory standards (e.g. NCQA, CMS, Joint Commission) and pertinent client requirements
    1. Participates in the monthly compliance office hours and monthly company wide compliance reviews
    2. Assists in showing our commitment to continuous improvement by helping to maintain and improve policy and procedure documents with updates from weekly/monthly sessions
    3. Performs and tracks pre-hire and monthly OIG and SAM reviews of CredSimple staff and consultants
    4. Maintains the CredSimple Employee Human Resources Database and the Education Proxy Database
    5. Helps to maintain and continuously improve the internal, ongoing audit process
      1. Collaborate with Operations to develop a rigorous, efficient, and practical approach to both quality auditing and continuous process improvement
      2. Perform relevant internal and external audits (e.g. clients and/or vendors)
  3. Work closely with the Director of Compliance to build, maintain, and add to CredSimple’s Compliance and Credentialing internal knowledge base, and leverage it to develop the CredSimple team. Ensure team members are informed and conversant about the regulatory framework for healthcare credentialing and provider data
    1. Proactively researches and tracks State and Federal rules and regulations, ensuring CredSimple remains abreast of and compliant with changing regulations
    2. Ensures CredSimple staff stays aware in advance and fully comprehends changes to all relevant State and Federal regulations
    3. Performs ongoing research on legislation and changing regulations as well as communicates relevant updates and feedback to appropriate internal stakeholders
    4. Develop and keep up-to-date a compliance onboarding program and ongoing training curriculum
  4. Serve as compliance and quality subject matter expert for internal and external clients in conjunction with the Director of Compliance
    1. Support Sales, Service Delivery, and Product and Engineering
    2. Support client-specific inquiries
    3. Support “client ready” development and delivery of any requested paperwork and documentation to fulfill the internal or external auditing needs of clients and prospects


Behavioral Competencies Required

  1. Attention to detail — Does not let important details slip through the cracks or derail a project. Specifically, carefully reviews complex or ambiguous regulation and correctly identifies exceptions; can audit work performed with high attention to detail and catch the mistakes of others without needing own work checked
  2. Compliance/Policy mindset — Proficient at reading regulatory and legal jargon and crafting thoughtful summaries/summary briefs and processes for a general audience to ensure compliance
  3. Professionalism — exemplifies professional, ethical conduct as a representative of CredSimple in a wide variety of areas, both internally and externally
  4. Organization and Planning – Excellent skills in planning and continual oversight to ensure CredSimple meets high-quality product/service delivery and compliance requirements
  5. Ownership – Owning everything in your domain, you go the extra mile and take responsibility and initiative to get the job done

Organization Competencies Required

  1. Works hard and smart – Delivers value consistently by being inquisitive, having a high degree of accountability and working with intent
  2. Driven – Fueled by passion and commitment, showing tenacity to overcome obstacles.
  3. Outcomes oriented – Dedicated to results. Track record of improving performance
  4. Effective communication – Speaks and writes clearly and directly with appropriate level of detail to communicate an idea. Happy to embrace the ideas of others if they improve on your own. Understands that clarity is measured at the recipient's ear, not the speaker’s mouth
  5. Teamwork – Work across team lines to value others’ contributions and support each other and drive everyone forward. #OneTeam

Requirements and Qualifications

  1. Certified as CPMSM or CPCS preferred. If not knowledge in all aspects of Credentialing
  2. Proficiency in the Google suite of products.
  3. 3+ years of healthcare experience preferred

Please apply directly via our website https://www.credsimple.com/careers/

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