Core Responsibilities - Exclusion Screening
• Operate enterprise screening for employees, contractors, and vendors.
• Perform checks against OIG LEIE, SAM.gov, State Medicaid exclusions, and OFAC/sanctions.
• Use screening platforms (Certiphi, LexisNexis, Refinitiv, Exiger or equivalent) to adjudicate hits and document decisions.
• Escalate confirmed/high-risk matches to Legal, HR, Compliance, and Operations.
• Manage periodic re-screening cycles and maintain audit-ready evidence.
Core Responsibilities - Vendor Compliance / TPRM
• Support onboarding due diligence, ongoing monitoring, and re-certifications.
• Track and validate vendor compliance artifacts and attestations.
• Partner with Procurement, Legal, InfoSec, and Business Owners to remediate gaps.
• Maintain records and evidence in AuditBoard or designated GRC systems.
Core Responsibilities - CMS Audit Support
• Serve as a primary contributor for CMS audits and related state/payer audits.
• Prepare and maintain audit-ready documentation (policies, SOPs, control narratives, evidence).
• Coordinate audit requests, walkthroughs, and evidence submissions using AuditBoard.
• Track audit findings and manage CAPs to closure with evidence.
• Participate in mock audits and readiness reviews.
Compliance Operations, GRC & Reporting
• Use AuditBoard to manage Incidents, Issues, Actions (CAPs), Evidence, and Dashboards.
• Produce management and governance reporting on screening, vendor compliance, and audits.
• Draft and maintain SOPs, job aids, and process documentation.
Issue Management & Remediation
• Log and manage issues related to screening, vendor compliance, and audit findings.
• Drive CAPs to on-time closure and validate effectiveness.
• Escalate high-risk or overdue issues appropriately.
Training & Stakeholder Advisory
• Guide HR, Procurement, Operations, and Business Leaders on screening and vendor compliance.
• Support training on CMS audit expectations and evidence standards.
Tools & Systems
• AuditBoard (or equivalent GRC)
• Screening platforms: Certiphi, LexisNexis, Refinitiv, Exiger (or equivalent)
• OIG LEIE, SAM.gov, State Medicaid lists, OFAC
• Excel/BI and workflow/case management tools
Qualifications & Experience
• Bachelor's degree (or equivalent experience).
• 5+ years in healthcare compliance, exclusion screening, vendor compliance, or audit support.
• Demonstrated experience supporting CMS audits, state audits, or payer audits.
• Strong knowledge of OIG/CMS expectations and audit evidence standards.
• Experience with AuditBoard or similar GRC tools preferred.
Key Competencies
• CMS audit and healthcare regulatory acumen
• Risk and control mindset
• Audit and evidence rigor
• Process improvement and automation mindset
• Stakeholder management and communication
Performance Metrics (KPIs)
• % populations screened on time
• Hit adjudication turnaround time
• Vendor compliance completion rate
• CMS audit findings count and severity
• CAP on-time closure rate
• Evidence completeness and audit re-use rate
Internal Leveling Alignment
• Compliance Analyst (C2): Executes screenings and supports audits
• Senior Compliance Analyst (C3 - this role): Owns operations and leads CMS audit support
• Lead/Principal (C4): Designs program and leads domain audits
• Manager (M1): Owns outcomes, staffing, executive and board reporting
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