Sr. Compliance Specialist

3 weeks ago

Harrisburg, United States Capital BlueCross Full time

Position Description:

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and its why our employees consistently vote us one of the Best Places to Work in PA.

The Senior Compliance Specialist is a subject-matter expert responsible for assisting business areas to achieve and/or maintain compliance with applicable regulatory and compliance program requirements. The incumbent is engaged directly with operational areas and takes a leading role in cross-functional projects that involve complex compliance matters. The Senior Compliance Specialist serves as a point of contact to respond to compliance inquires and/or to assist in resolving compliance issues.

Responsibilities and Qualifications:
  • Provides compliance advisory services to internal customers by assisting them to understand regulatory requirements, implement compliant solutions and establish adequate monitoring mechanisms.
  • Receives, logs, researches, analyzes, and responds to compliance inquiries, related to regulatory requirements and guidance, as well as other compliance issues.
  • Oversees and administers the Incident Reporting and Corrective Action process to ensure that compliance issues are identified, addressed, and resolved on a timely basis.
  • Takes a leading role in cross-functional projects or committees aimed at implementing operational changes to achieve or maintain compliance with regulatory requirements.
  • Conducts oversight activities of FDRs, Delegate Entities and/or CHIP subcontractors, as applicable.
  • Assists in the development and maintenance of compliance monitoring activities and strategies and assists in the performance of risk assessments.
  • Leads or provides support during internal and external audits, as appropriate, and monitors the completion of corrective action plans.
  • Performs assigned duties as part of the Regulatory Intake process.
  • Prepares, coordinates and/or submits required regulatory filings or reports.
  • Develops and maintains internal departmental policies and procedures and assists business areas in developing and implementing policies and procedures.
  • Develop and lead training on specific compliance topics.
  • Performs other tasks as assigned by the Compliance Officer or the Chief Compliance Officer.
  • For Medicare Compliance positions: Complete analysis of CMS Proposed and Final Rules and work with assigned business areas on implementation and oversight. Review Medicare Advantage bulletins from the Blue Cross and Blue Shield Association (BCBSA) to determine business impact and distribution.

Skills:

  • Strong leadership and communication skills.
  • Demonstrated ability to communicate (verbally and in writing) and to collaborate effectively cross-functionally and within the department, at all levels.
  • Demonstrated ability to understand regulations and guidance and apply them to specific facts and situations.
  • Demonstrated ability to work independently, effectively handle changing priorities, and to know when to request input from the Compliance Officer.
  • Demonstrated ability to persuade and negotiate to resolve differences with skill and understanding.
  • Demonstrated ability to manage projects in a timely and efficient manner.
  • Demonstrated ability to discreetly handle highly confidential information and issues.
  • Ability and willingness to mentor other department personnel.
  • Ability and demonstrated experience analyzing new laws and regulations e.g. Medicare Advantage, Affordable Care Act and CHIP

Knowledge:

  • Comprehensive knowledge of Compliance Program requirements.
  • Knowledge of applicable regulatory standards and regulations (e.g., Medicare Advantage, Affordable Care Act, CHIP, as applicable).
  • Broad knowledge of the health insurance industry, including knowledge of standards, policies, and business practices and procedures related to compliance.
  • Familiar with internal and external audit procedures.

Experience:

  • 5 years experience in health insurance compliance or related field (Medicare Advantage, Affordable Care Act and/or CHIP, as applicable).
  • Experience interacting with regulators preferred (CMS, PID, DHS, as applicable).
  • Relevant audit and/or operational experience preferred.

Education and Certifications:

  • Bachelor's degree or 9 years of relevant experience in lieu of degree.
  • Certification in Health Care Compliance (CHC) preferred.


About Us:
We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.

And by doing your best, youll help us live our mission of improving the health and well-being of our members and the communities in which they live.

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