Senior Compliance Consultant

About the role

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with us.

Responsibilities

• Carries out compliance reviews providing reasonable assurance that company personnel and/or applicable third-party vendors are complying with current corporate policies and all laws and regulations.
• Collects and prepares information to support Divisional Management.
• Provides recommendations to better manage risks, strengthen internal controls and deter and reduce non-compliance.
• Reviews compliance procedures and reports findings to management.
• Affords support for external agencies' regulatory and compliance audits, including DOI Exams, CMS Audits, BCBSA Audits, applicable Third Party Delegated Entities (DDE) audits, and/or scheduled special reviews as assigned.

Requirements

• Education: Bachelor's in Business Administration, Health Administration or a related field required; Master's in related field preferred.
• Experience: Minimum of 4 years of experience in a predominantly audit and analytical position related to compliance or audit. Compliance Audit experience is preferred.
• Work Experience: Previous experience in commercial or government compliance programs such as Medicare Advantage, Medicaid, Commercial, or Health Care Reform is required. Preferred experience for Medicare Compliance includes Medicare plans and services, Medicare related regulatory requirements. Preferred experience for Commercial Compliance includes Privacy and ethics, Business code of conduct and compliance, Fraud investigation practices. Preferred experience for Information Governance Office includes Privacy regulations and standards, Information governance / records management practices, Incident response / internal investigation experience. Preferred experience for Vendor Compliance includes Third Party/vendor contract terms, compliance, and controls requirements related to delegated services, Working knowledge of accreditation standards and requirements for URAC and /or NCQA, General audit standards, processes and practices, Prior clinical environment experience and/or strong working knowledge of clinical practices.

Qualifications

• Strong human relation skills in addition to analytical ability.
• Strong communication skills both written and oral.
• Ability to manage time and personnel on a project and everyday basis.
• Working knowledge of relevant software.
• Maintain complete confidentiality of information encountered.
• Ability to work extended hours with some travel required.

Skills

• An advanced healthcare related industry certification such as CIA, CPA, CHC preferred.

Accountabilities and Essential Functions

• Independently conducts basic to complex audits, reviews, periodic evaluations and special reviews as identified in annual risk assessment or as specified by management, to determine company’s compliance with laws and regulations.
• Remains current with applicable State and Federal laws and regulations and may include standard operating procedures relevant to the Code of Business Conduct and Compliance program, to determine the company’s state of compliance.
• Advises applicable management of changes and new regulations and helps ensure that their assigned area is tracking all applicable State and Federal laws and regulations in applicable databases.
• Conducts special reviews, which may include ethics investigations originating as a result of alleged violations of the Code of Conduct (including fraud, abuses, and other related improprieties) and reports findings to applicable management.
• Advises various levels of personnel on compliance issues related to organization products and services, third party delegated products and services, and applicable regulations and laws, where applicable, to ensure the company is in compliance.
• Serves as a Compliance subject matter expert to other areas of the company as needed.
• Completes assigned portions of the department’s risk assessment and helps guide the overall risk assessment effort.
• Affords assistance to department management in other areas, as assigned to include training and education of the Company employees regarding applicable Compliance program(s) and other compliance related education to ensure employee understanding of compliance and where applicable ethics.
• When requested, and under minimal supervision of department management, leads, coordinates and/or assists with external audits, special projects and examinations to ensure their successful completion.

Additional Accountabilities and Essential Functions

• Perform other job-related duties as assigned, within your scope of responsibilities.

Job duties

• Performed in a normal and clean office environment with normal noise levels.
• Primarily performed while standing or sitting.
• Required to comprehend, document, calculate, visualize, and analyze.

Physical Demands

• Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions.

Equal Opportunity Employer

All internal employees please apply through Workday Careers. PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)

Additional Information

• Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.
• If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.
• In support of our mission to improve the health and lives of Louisianians, we encourage the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
• We perform background and pre-employment drug screening after an offer has been extended and prior to hire for all positions.
• As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus.
• Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
• Additionally, we are a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.

JOB CATEGORY: Legal, Compliance & Audit