Compliance Mgr Job


About Blue Cross



At Blue Cross and Blue Shield of Minnesota, we are developing industry-leading strategies every day that make a healthy difference in people’s lives. Blue Cross has a legacy of improving health through innovation because we believe that everyone should have the opportunity to live the healthiest life possible. Chartered in 1933 as the state’s first health plan, we’ve been serving the health care needs of Minnesotans for more than 80 years.



Blue Cross supports you with competitive pay and a comprehensive benefits package. Many Employee Resource Groups are active in the company, promoting inclusion and helping us meet the diverse needs of our workforce and our members. Join us, and enjoy a work environment where all employees are respected and valued — a workplace honored with a perfect score on the Human Rights Campaign Corporate Equality Index for 2017. Find your place at a company that cares.



 


Description Summary

The purpose of this position is to develop, implement, continuously monitor and improve the Regional Medicare Programs. This position is responsible for managing the activities associated with Regional compliance activities including CMC, vendor and Alliance Plan interactions. This position is responsible for ensuring that the oversight and operations are meeting regulatory compliance and that new (applicable) state and federal legislation information is communicated, implemented and maintained with respect to company products and operations. In addition, this person will assist in carrying out the compliance assessment goals, work schedules, assessment activity, and reporting.


Accountabilities


  1. Establish and maintain a positive working relationship with CMS/DHS/OIG and other regulatory agencies and industry leaders to identify regulatory issues that impact the Medicare/Medicaid business.

  2. Develop processes and reports to oversee and monitor the regional activities to ensure compliance with CMS and contractual requirements.

  3. Work with CMC, regional vendors, and Alliance Plans to educate, train, implement self monitoring, audit and corrective action plans.

  4. Establish and maintain a comprehensive understanding of all new and existing laws, regulations and other requirements that impact our products and operations in order to provide guidance to analysts on contract language filings and implementation and other compliance strategies.

  5. Manage the identification, interpretation, education and implementation of Medicare Modernization Act, Medicare Managed Care Manual and CMS Monitoring Guide requirements. Review cross functional Polices and Procedures across the enterprise to ensure adherence to compliance requirements.

  6. Coordinate with any internal audit functions to ensure CMS required audits are completed according to regulatory requirements using assessment tools and corrective action plans.

  7. Develop and implement audit plans, self monitoring and audit tools to monitor and track compliance.


Requirements


  • Bachelor’s degree and 5 years experience in the health care industry with specific ethics/compliance program knowledge and experience in Medicare and Medicaid Programs required.

  • 3 years experience managing project(s) involving multiple team members and including task assignment, working with key customers (internal or external), managing team and customer relationships and managing project deliverables.

  • Detailed knowledge of the U.S. Sentencing Guidelines, the development of Government Programs Compliance Plans, Medicare Advantage and Medicaid Products.  

  • Proven ability to work with CMS/State Regulators.  

  • Knowledge of Health Plan operations including claims, enrollment, sales and marketing, health services and membership.

  • Fundamental knowledge of health insurance regulation at both federal and state levels.

  • Proven experience in the development and implementation of corporate regulatory compliance and ethics programs.

  • Demonstrated success in a leadership position.  

  • Significant training experience including program development and implementation.

  • Well-developed analytical, problem-solving and communication skills.

  • Business Analysis expertise and ability to translate regulatory requirements into operation.

  • In depth understanding and experience in application development and submission to the Federal Government on Medicare Products.

  • Advanced understanding of Part D regulatory requirement.


Preferred Requirements

FLSA Status

Exempt

Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



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Thank you for your interest in Blue Cross. Be part of a company that lets you be you — and make a healthy difference in people’s lives every day



Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association