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CredSimple // cloud-based healthcare credential verification
New York    Posted: Thursday, December 12, 2019
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CredSimple is building a healthcare technology company that serves the $10B niche of provider network management. Were 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. Were solving very real & challenging problems in the healthcare industry.

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

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


The Role

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

The outcomes were looking for

  1. Assist in ensuring that CredSimple remains in continuous compliance with all NCQA guidelines, & passes all NCQA audits with the highest marks (100% of NCQA elements passed with >99% on each element)
    1. Maintains internal compliance documentation & 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 CredSimples process & procedures comply with State, Federal, & non-governmental/industry regulatory standards (e.g. NCQA, CMS, Joint Commission) & pertinent client requirements
    1. Participates in the monthly compliance office hours & monthly company wide compliance reviews
    2. Assists in showing our commitment to continuous improvement by helping to maintain & improve policy & procedure documents with updates from weekly/monthly sessions
    3. Performs & tracks pre-hire & monthly OIG & SAM reviews of CredSimple staff & consultants
    4. Maintains the CredSimple Employee Human Resources Database & the Education Proxy Database
    5. Helps to maintain & continuously improve the internal, ongoing audit process
      1. Collaborate with Operations to develop a rigorous, efficient, & practical approach to both quality auditing & continuous process improvement
      2. Perform relevant internal & external audits (e.g. clients and/or vendors)
  3. Work closely with the Director of Compliance to build, maintain, & add to CredSimples Compliance & Credentialing internal knowledge base, & leverage it to develop the CredSimple team. Ensure team members are informed & conversant about the regulatory framework for healthcare credentialing & provider data
    1. Proactively researches & tracks State & Federal rules & regulations, ensuring CredSimple remains abreast of & compliant with changing regulations
    2. Ensures CredSimple staff stays aware in advance & fully comprehends changes to all relevant State & Federal regulations
    3. Performs ongoing research on legislation & changing regulations as well as communicates relevant updates & feedback to appropriate internal stakeholders
    4. Develop & keep up-to-date a compliance onboarding program & ongoing training curriculum
  4. Serve as compliance & quality subject matter expert for internal & external clients in conjunction with the Director of Compliance
    1. Support Sales, Service Delivery, & Product & Engineering
    2. Support client-specific inquiries
    3. Support client ready development & delivery of any requested paperwork & documentation to fulfill the internal or external auditing needs of clients & 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 & correctly identifies exceptions; can audit work performed with high attention to detail & catch the mistakes of others without needing own work checked
  2. Compliance/Policy mindset Proficient at reading regulatory & legal jargon & crafting thoughtful summaries/summary briefs & 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 & externally
  4. Organization & Planning Excellent skills in planning & continual oversight to ensure CredSimple meets high-quality product/service delivery & compliance requirements
  5. Ownership Owning everything in your domain, you go the extra mile & take responsibility & initiative to get the job done

Organization Competencies Required

  1. Works hard & smart Delivers value consistently by being inquisitive, having a high degree of accountability & working with intent
  2. Driven Fueled by passion & commitment, showing tenacity to overcome obstacles.
  3. Outcomes oriented Dedicated to results. Track record of improving performance
  4. Effective communication Speaks & writes clearly & 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 speakers mouth
  5. Teamwork Work across team lines to value others contributions & support each other & drive everyone forward. #OneTeam

Requirements & 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

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