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.
Residency in or relocation to Louisiana is preferred for all positions.
Applicants must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support. Louisiana Blue will not provide current or future employment-based immigration sponsorship or other immigration support for this opportunity, including H-1B, L-1, O-1, H-1B1, E-3, TN, or J-1 sponsorship or F-1 OPT/STEM OPT/CPT support. Applicants who would require such sponsorship or employer support during their employment should not pursue this opportunity.
POSITION PURPOSEResponsible for carrying out compliance reviews that provide reasonable assurance company personnel and/or applicable third-party vendors are complying with current corporate policies and all laws and regulations. Collects and prepares information to provide support to Divisional Management. Provides management with recommendations to better manage risks, strengthen internal controls and deter and reduce non-compliance. Reviews compliance procedures and reports on findings to management. Assists Management in coordination of external agencies regulatory and compliance audits that may include DOI Exams, CMS Audits, BCBSA Audits, applicable Third Party Delegated Entities (DDE) audits, and/or scheduled special reviews as assigned. Accountable for complying with all laws and regulations associated with duties and responsibilities.
NATURE AND SCOPE- This role does not manage people
- This job reports to: Departmental Leadership
- Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with:
Internal - All levels of company management and personnel. Moderate involvement and exposure to senior management team.
External - Consultants, auditors, investigators, regulatory bodies, BCBS Association, and other external sources that may provide information for a review such as providers and other Blue Cross plans.
QUALIFICATIONSEducation- Bachelor's in Business Administration, Health Administration or a related field as deemed necessary by department management required
- Master's in related field preferred
- Four years of related experience can be used in lieu of a Bachelor’s degree.
Work Experience- Must have a minimum of 4 years of experience in a predominantly audit and analytical position related to compliance or audit. Compliance Audit experience is preferred.
- 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: Medicare plans and services, Medicare related regulatory requirements
- Preferred experience for Commercial Compliance: Privacy and ethics, Business code of conduct and compliance, Fraud investigation practices
- Preferred experience for Information Governance Office: Privacy regulations and standards, Information governance / records management practices, Incident response / internal investigation experience
- Preferred experience for Vendor Compliance: 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
Skills and Abilities- Position requires strong human relation skills in addition to analytical ability. Also, strong communication skills both written and oral.
- Ability to manage time and personnel on a project and everyday basis.
- Working knowledge of relevant software is required.
- Incumbent must maintain complete confidentiality of information encountered.
- Ability to work extended hours with some travel required.
Licenses and Certifications- An advanced healthcare related industry certification such as CIA, CPA, CHC preferred
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS- With minimal supervision by department management, 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.
- Actively researches and 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.
- With minimal supervision, 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.
- As assigned by department management, completes assigned portions of the department’s risk assessment and helps guide the overall risk assessment effort.
- Assists department management in other areas, as assigned to include training and education of the Company employees regarding audience 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 FunctionsThe Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions- Perform other job-related duties as assigned, within your scope of responsibilities.
- Job duties are performed in a normal and clean office environment with normal noise levels.
- Work is predominately done while standing or sitting.
- The ability to comprehend, document, calculate, visualize, and analyze are required.
An 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.
