OneMain Financial Jobs

Overview Directs the response to audits related to Medicare and Medicaid billing compliance for VNS Health's provider lines of business - i.e., VNS Health Home Care, VNS Health Hospice Care, VNS Health Behavioral Health, VNS Health Personal Care, and Medical Care at Home, P.C. Ensures regulatory adherence in the delivery of home health, hospice, and behavioral health services, with particular expertise in claims review and submission, denial management, claim reversals, and administrative appeals. Directs Compliance-program activities related to internal and external audits, policy and procedure development, trainings and education, and related projects. Directs regulatory review and coordinates with Legal for all required self-disclosures to government and other payors.Serves as a high-level subject matter expert on Medicare and New York State Medicaid billing regulations and plays a critical role in protecting revenue integrity and mitigating compliance risk. Works cross-functionally with compliance operations, clinical operations, quality, education, and revenue cycle teams, provides strategic guidance on clinical documentation risk, and leads the response to major external audits-including those conducted by CMS, the New York State Department of Health (NYSDOH), and the New York State Office of the Medicaid Inspector General (OMIG). Develops and drafts clear, persuasive clinical and regulatory arguments in response to claim denials and disallowances. Works under general supervision. 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 opportunitiesWhat You Will Do * Directs complex, large-scale condition of payment and related audits from federal and state agencies (e.g., CMS, NYSDOH, OMIG, UPICs, MACs). Oversees response to routine audits including RACs and CERTS, working in close collaboration with the line of business Directors responsible for regulatory compliance and performance improvement, as well as the corporate Quality and Education departments. * For audits managed by the Compliance and Legal teams, serve as project manager for all phases of the audit lifecycle, ensuring strategic coordination, documentation readiness, and effective cross-functional collaboration. Analyzes audit findings and identify grounds for rebuttal based on medical necessity, documentation sufficiency, and regulatory interpretation. * Acts as the primary Compliance liaison to auditors and government regulators for condition of payment and related audits, reports, and related inquiries. Provides support for other surveys, reports, and inquiries that are managed by quality and operational teams. * Drafts clear, concise, and persuasive appeals, position statements, and rebuttals grounded in clinical and legal reasoning. * Coordinates with legal, clinical, quality, education, and revenue cycle teams to strengthen submissions and to support overturning and mitigating compliance-managed audit findings or claim denials. Oversees related billing denial management, appeal workflows, and root cause analysis of disallowances. * Ensures compliant billing practices for all Medicare and Medicaid claims, including New York-specific rules for home health, hospice, and behavioral health services. * Partners with billing and clinical teams to prevent repeat errors and ensure accurate coding and documentation. * Manages end-to-end processes