Health Care Network Compliance Senior Specialist

Job Description This is a hybrid position based in the Miami‑Dade area, requiring regular local travel. Candidates must reside within Miami‑Dade County and be comfortable with travel throughout the region. When not in the field, the role offers the flexibility to work remotely. Myers and Stauffer is seeking an observant, detail‑oriented, and reliable Compliance Senior Specialist to support the Network Adequacy team. This position involves evaluating adequate health plan provider networks through onsite visits, telephonic surveys of healthcare providers, and assessing the accuracy of provider directories. As a Health Care Network Compliance Senior Specialist, you will play a vital role in ensuring healthcare members receive access to quality care, while supporting compliance with regulatory standards. This is an excellent opportunity for those with a keen eye for detail and a passion for improving the healthcare experience. Essential Functions And Primary Duties Review, summarize, and apply Federal and State Medicaid and/or Medicare policies and regulations, ensuring operational and program compliance. Conduct onsite and telephonic surveys (as a "secret shopper") to assess the availability, accessibility, and quality of healthcare providers in the health plan network. Evaluate compliance with network adequacy standards, including geographic coverage and timeliness of care. Use provided evaluation criteria, checklists, and protocols to document observations accurately and comprehensively. Maintain detailed and organized records of all evaluations, ensuring confidentiality and adherence to reporting standards. Submit clear and well‑documented reports summarizing survey outcomes, patterns, and issues encountered during secret shopping activities. Collaborate with the team to improve processes, share insights, and contribute to actionable recommendations for enhancing network performance. Ability to adapt to using tools such as Qualtrics survey platform, 8x8 Computer‑Assisted Telephone Interviewing (CATI) platforms and various AI models. Support stakeholder engagement activities; supporting trainings and training materials as needed. Maintain professional behavior while conducting assessments in both onsite and telephonic settings. Additional responsibilities as assigned. Preferred Qualifications Bachelor’s degree in health policy, health care administration, health information, public health, social services, criminal justice, business, or related field preferred. Ability to adhere to strict confidentiality guidelines and maintain professionalism. Proficiency in data entry tools and Microsoft Office Suite (Word, Excel). Strong organizational and time management skills to manage assignments effectively and meet deadlines. Strong written and verbal communication skills. Bilingual in English and Spanish. Reliable transportation to conduct onsite evaluations. Ability to travel up to 30% of time in the Miami‑Dade area. Prior experience in any of the following roles: secret shopper, healthcare compliance, auditing, program integrity, health plan provider/member enrollment, customer care call center. Familiarity with healthcare networks, provider enrollment processes, and/or patient services. Willingness to provide unbiased feedback based on observations rather than personal opinions or biases. Ability to work flexible hours to accommodate various assignments. Minimum Qualifications High School diploma or GED About Us Myers and Stauffer LC is a certified public accounting and health and human services consulting firm, specializing in audit, accounting, data management and consulting services to government‑sponsored health care programs (primarily state Medicaid agencies, and the federal Center for Medicare & Medicaid Services). We have 45+ years of experience assisting our government clients with complex health care reimbursement and provider compliance issues, operate 21 offices and have over 900 associates nationwide. At Myers and Stauffer, you will have a career that is rewarding while also supporting our state and federal government health and human service clients that focus on those in need. We are committed to providing our employees with professional growth and development opportunities, a diverse, dynamic, challenging work environment, and a strong and visionary leadership team. Our firm takes pride in the welcoming and collaborative culture we have throughout our offices. We are always willing to discuss potential flexibility that an employee may need to better suit their work‑life wellbeing. What We Offer Health, Dental, and Vision insurance along with other competitive employee benefits for eligible associates Vacation time, sick time, and paid holidays Paid Parental Leave and available support resources 401K with company matching for eligible employees Tuition reimbursement, referral bonuses, paid volunteer community service time, mentor program, and a variety of other employee programs and perks A combination of technical and leadership development training at each career milestone Up to six counseling sessions per year for eligible employees through our Employee Assistance Program #J-18808-Ljbffr Myers and Stauffer LC