Resp & Qualifications

PURPOSE: 
This role will support the division and corporate compliance in the delivery and performance of a compliance program to help ensure compliance and alignment with Federal, State, and related regulatory statutes, as well as company policies for CareFirst plans. As a compliance function, this role will perform and support the Division's accountability for efforts supporting the corporate and divisional risk management helping to ensure (i) compliance with laws, regulations policies, and procedures; (ii) reliability of reporting; (iii) efficiency and effectiveness of operations; in order to support company and division goals and objectives.

ESSENTIAL FUNCTIONS:

• Support the Division's Embedded Compliance department in driving accountability for Compliance activities and in support of the achievement Divisional goals. Supports the execution of a compliance program to effectively implement, revise and test controls and continuously reviews and improves departmental policies and procedures to achieve greater efficiencies and effectiveness. Acts as a liaison across areas internally including of Health Services, Corporate Audit, Corporate Compliance, Finance, and Legal.
• Provide regular investigative, analytic and audit reporting data to stakeholders. Monitors, assesses, and reports significant matters to senior management.  Support Audits and manages the activities related to reviewing audit findings with stakeholders. Works with divisions management to establish and implement corrective action plan as an outcome of audit findings.
• Regular monitoring and control of corrective action plan implementation and communication/reporting of risk associated with the control deficiencies identified to all stakeholders.  Actively participate in implementation/corrective work groups to ensure compliance perspective and concerns are addressed through the process.
• Continuously analyzes and aligns functional area policies, procedures, SOPs, workflows, and systems and ensure they comply and align with regulations and remain updated and current. Reviews complex business processes, systems, workflows, SOPs and policies, procedures to identify, document, and elevate the presence of risks and trends within, that may be non-compliant with contracts and or statutory requirements.
• Ensure documentation is developed and maintained to support progress of projects. Drives the development of workflow process to manage the impact of various projects on multi-departmental workforces and their daily activities.
• Works directly with the divisions Training teams to ensure training content incorporates necessary procedures, SOPs, workflows, etc. applicable to the policies.  Keeps abreast of emerging issues and developments that have direct impact on the division.

QUALIFICATIONS:

Education Level: Bachelor's Degree in Business Administration, Healthcare Compliance or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Licenses/Certifications:

• CHC - Certified Healthcare Compliance Preferred or
• CRCM - Certified Risk and Compliance Professional Preferred or
• Lean Six Sigma Certification-IASSC Preferred or
• Certified Regulation Analyst Preferred or
• Certified Compliance & Ethics Professional (CCEP) Preferred

Experience: 5 years experience in health insurance industry, managed care and government programs, health insurance compliance programs, or related fields.

Preferred Qualifications:

• Healthcare Compliance certification(s).
• Experience in CMS programs (Medicare or Medicaid, project management, business process analysis, workflow, and task analysis.
• Process Improvement Systems training in Six Sigma, Lean, or other Business Process Improvement tools.

Knowledge, Skills and Abilities (KSAs)

• Excellent interpersonal skills with ability to build consensus and agreement and bring resolution to contentious issues and entrenched interests.
• Ability to present and discuss regulatory compliance goals in a way that establishes rapport, persuades others, and gains commitment.
• Ability to research complex issues, interpret regulations and regulatory rules/guidance, and exhibit sound judgment in determining a recommendation or solution to a problem.
• Word, Advanced Excel and database management and related software applications.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $68,400 - $135,850

Travel Requirements
Estimate Amount: 5% Travel to CareFirst locations or training may be necessary.

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Medicare and Medicaid Compliance

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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