Contract Auditor

Conducts regulatory, credentialing, and contractual compliance audits for designated Network providers, including Social Adult Day Cares (SADCs), Consumer Directed Personal Assistance Services (CDPAS)/Fiscal Intermediaries (FIs), and Licensed Home Care Service Agencies (LHCSAs). Evaluates provider compliance with New York State regulatory requirements and VNS Health contractual standards through on-site audits, documentation reviews, risk assessments, and follow-up corrective action monitoring. Partners with Network leadership and internal stakeholders to identify compliance risks, improve provider performance, support regulatory readiness, and ensure contracted agencies maintain operational standards necessary to deliver quality services to members.

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Conducts scheduled and targeted on-site compliance audits for SADC, CDPAS/FI, and LHCSA providers.
• Evaluates provider adherence to regulatory requirements, contractual obligations, credentialing standards, and VNS Health policies.
• Reviews provider documentation, operational processes, staffing qualifications, training records, and required regulatory materials.
• Develops audit findings, scoring summaries, corrective action requirements, and recommendations for improvement.
• Monitors provider corrective action plans and perform follow-up reviews to validate remediation.
• Maintains audit tracking, documentation, reporting, and audit calendars.
• Identifies trends, recurring deficiencies, and opportunities for provider education and process improvement.
• Collaborates with Network, Compliance, Quality, Operations, Claims, and other internal teams on provider performance concerns.
• Supports regulatory audits and special projects as assigned.
• Travels throughout Downstate NYC to conduct on-site audits, complaint investigations, and regulatory reviews in order to meet oversight and compliance requirements. This role will require 90% travel.
• Communicates proactively and collaborate with internal departments to ensure regulatory alignment, operational efficiency, and effective resolution of compliance matters.
• Participates in special projects and performs other duties as assigned.

Education:
Associate's Degree or equivalent work experience required
Bachelor's Degree in Business Administration, Finance, Accounting or related field preferred

Work Experience:
Minimum 3 years contract-related experience in the health care field including, but not limited to, provider's office, managed care organization, or other health care or regulatory environment, or equivalent combination of relevant education and experience required
Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare required
Resides in Downstate NY preferred
Experience / knowledge of SADC's required
Compliance requirements (OSHA / ADA) required