United States onlySagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.
Job title:
Job Description:
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
