Vendor Audit and Compliance Specialist

Vendor Audit and Compliance Specialist

Work from home within Oregon, Washington, Idaho or Utah 

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.  

Who We Are Looking For: 

Every day, Cambia’s dedicated team of Vendor Audit and Compliance Specialists are living our mission to make health care easier and lives better. As a member of the Quality team, our Vendor Audit and Compliance Specialist oversees delegated business functions across multiple product lines, ensuring third-party vendors meet organizational standards and regulatory requirements. This role conducts pre-delegation assessments, ongoing oversight, and audits of delegated entities, focusing on their operational processes, documentation, and reporting capabilities. The position involves evaluating clinical care quality, utilization management, and case management while collaborating with clinical and administrative professionals. Key interactions include internal management, vendors, government officials, and accrediting agencies. The specialist must effectively analyze data, resolve complex compliance issues, and ensure all delegated activities align with regulatory and accreditation guidelines – all in service of creating a person-focused health care experience.

Are you a detail-oriented professional who thrives on ensuring operational excellence and compliance? Do you excel at building relationships while maintaining strict regulatory standards? Then this role may be the perfect fit.

What You Bring to Cambia: 

Qualifications:  

• Bachelor's degree and 6 years of progressive experience in health care administration, as a project leader or project support or a related experience, or an equivalent combination and education is required.

• At least three years of experience must be in coordination and oversight of health-care related delegation activities and contracting.

• Master’s degree is preferred.

Skills and Attributes: 

• Possesses comprehensive understanding of managed care systems and their core principles

• Can effectively implement and manage delegation programs that align with company-wide initiatives and strategic objectives

• Excels in project-related tasks including creating reports, maintaining documentation, writing policies, and analyzing data - with a knack for turning complex statistics into clear corporate communications

• Well-versed in healthcare regulatory requirements and quality benchmarks, including Medicare standards, URAC certification, and NCQA guidelines

• Skilled at evaluating clinical service needs within delegated contracts and determining areas for growth

• Expert at juggling multiple projects and meeting deadlines through strong project management capabilities

• Communicates effectively with external partners and delegated entities, maintaining clear channels of both written and verbal communication

• Demonstrates finesse in navigating complex situations, using diplomatic approaches to negotiate solutions and build consensus

• Builds strong relationships across all organizational levels through excellent communication skills and interpersonal abilities

• Shows strong analytical capabilities - can identify challenges, craft practical solutions, and successfully implement action plans

What You Will Do at Cambia:  

• Serves as the delegation Subject Matter Expert (SME), managing corporate-level projects and implementing administrative policies while providing team leadership and resource support.

• Develops and maintains comprehensive oversight policies for delegated functions, including credentialing, utilization management, case management, appeals, and claims processing, ensuring compliance with regulatory and accreditation requirements.

• Conducts thorough delegation oversight reviews, either on-site or virtually, utilizing standardized audit tools to evaluate performance and prepare detailed reports of findings.

• Manages the corrective action process by working with delegates to develop and implement improvement plans, monitoring progress, and escalating unresolved issues when necessary.

• Leads cross-divisional committees and develops comprehensive reports on delegation activities for leadership, while managing delegation-related reporting systems and defining business requirements.

• Coordinates effectively with internal departments and external delegates to schedule reviews, maintain communication channels, and ensure timely completion of all delegation-related activities.

• Responds to internal and external requests for proposals (RFPs) and information while serving as a key liaison between management levels and maintaining oversight of delegated contracts.

The expected hiring range for a Vendor Audit and Compliance Specialist is $91,800 - $124,200 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 10%.  The current full salary range for this role is $86,000 - $141,000.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care.  Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:  

• Work alongside diverse teams building cutting-edge solutions to transform health care.  
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.  
• Grow your career with a company committed to helping you succeed. 
• Give back to your community by participating in Cambia-supported outreach programs.  
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.  

We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.  

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include: 

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. 
• Annual employer contribution to a health savings account.  
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. 
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). 
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). 
• Award-winning wellness programs that reward you for participation. 
• Employee Assistance Fund for those in need. 
• Commute and parking benefits. 

Learn more about our benefits. 

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.