Medicaid Compliance Director

001 BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 110,000 - 170,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k retirement savings plan with公司

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is seeking a senior leader to oversee the organization’s compliance and privacy program. The role focuses on evaluating compliance issues, ensuring adherence to regulatory requirements, and guiding the board, senior management, and employees toward ethical conduct and policy adherence.

The position requires extensive experience in healthcare or insurance compliance, leadership, and the ability to coordinate across departments to address privacy and

Qualifications

• Ten+ years experience in a healthcare or insurance related organization or other relevant business experience.
• Two years demonstrated leadership experience in a supervisory/management role or equivalent military experience in grade E4 or above.

Responsibilities

• Oversees the compliance and privacy program and reviews for the organization.
• Develops, maintains, and revises policies and procedures for the compliance program.
• Monitors federal privacy laws and policy changes affecting the privacy program.
• Collaborates with departments to address compliance and privacy issues.
• Reports to the Board and senior management on compliance progress and issues.
• Ensures reporting of violations to enforcement agencies as required and promotes a confidential compliance hotline.

Skills

Compliance knowledge

QA compliance

HIPAA & HITECH

HR compliance

Interpersonal skills

Communication

Presentation & reporting

Education

Bachelor's degree

Tools

Microsoft Office

Job description

Summary

Responsible for overseeing the compliance and privacy program and reviews, and evaluates compliance issues/concerns within the organization. Ensures the board, senior management, and employees are in compliance with the rules and regulations of regulatory agencies, that company policies and procedures are being followed, and that behavior in the organization meets the company's standards of conduct.

What You’ll Do:

Develops, initiates, maintains, and revises policies, procedures, and work plans for the general operation of the compliance program and its related activities to ensure compliance with applicable regulations and prevent illegal, unethical, or improper conduct.

• Monitors federal privacy laws and policy changes that affect the privacy program;
• Allocates an appropriate allocation of budget and staffing recourses to implement and operate the organization-wide privacy program;
• Develops a strategic organizational privacy plan for implementing applicable privacy controls, policies, and procedures;
• Develops, disseminates, and implements operational privacy policies and procedures that govern the appropriate privacy and security controls for programs, information systems, or technologies involving PII;
• and Updates privacy plan policies, and procedures as required to address changing requirements, but at least biennially.
• Develops and oversees compliance training and/or educational initiatives for employees, board members, and subcontractors
• Collaborates with other departments to direct compliance and privacy issues to appropriate existing channels for investigation and resolution.
• Consults with the corporate legal department as needed to resolve difficult, legal compliance issues.
• Acts as an independent review and evaluation body to ensure that compliance issues/concerns within the organization are being appropriately evaluated, investigated, and resolved.
• Monitors new regulatory guidance ensuring new rules are evaluated and appropriately addressed.
• Responds to alleged violations of rules, regulations, policies, procedures, and standards of conduct by evaluating or recommending the initiation of investigative procedures.
• Develops and oversees a system for uniform handling of such violations.
• Monitors, and as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends.
• Identifies potential areas of compliance and privacy vulnerability and risk, develops/implements Corrective Action Plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future.
• Provides reports on a regular basis, and as directed or requested.
• May make formal presentations to the Board of Directors Compliance Committee during regularly scheduled board meetings to keep the board of directors and senior management informed of the operations and progress of compliance efforts.
• Ensures proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required.
• Institutes and maintains an effective compliance communication program for the organization, including promoting the use of the compliance hotline, a heightened awareness of standards of conduct, and the understanding of new and existing compliance issues and related policies and procedures.
• Works with the internal departments and others as appropriate to develop an effective compliance training program, including appropriate introductory training for new employees as well as ongoing training for all employees and managers.

What You’ll Need:

Required Education:

Bachelor's Degree Required

Work Experience:

Ten+ years experience in a healthcare or insurance related organization or other relevant business experience. Two years demonstrated leadership experience in a supervisory/management role or equivalent military experience in grade E4 or above. (may be concurrent)

Preferred Work Experience:

Working knowledge of South Carolina Department of Health and Human Services Medicaid Program and the Medicaid-Medicare Duals Program.

Skills and Abilities:

• Familiarity with legal and financial federal/state compliance procedures and regulations.
• Familiarity with quality assurance federal/state compliance procedures and regulations.
• Comprehensive knowledge of laws, policies, procedures, and practices regarding privacy and security of protected health information, including HIPAA and HITECH.
• Familiarity human resource federal/state compliance procedures and regulations.
• Ability to deal with ambiguity and time constraints.
• Ability to analyze and determine the applicability of interview findings.
• Ability to gather information by examining records and documents and interviewing individuals.
• Strong interpersonal skills.
• Ability to work professionally with persons at all levels.
• Ability to maintain effective working relationships.
• Ability to communicate clearly and effectively in oral and written form.
• Strong presentation, interviewing, and report writing skills with strong attention to detail.
• Excellent analytical or critical thinking and problem solving skills.
• Ability to make sound decisions.
• Ability to exercise confidentiality and discretion.

Software and Other Tools: Microsoft Office.

Work Environment: Typical office environment. Some out of town travel required at times. Some travel between office buildings required.

Our Comprehensive Benefits Package Includes The Following:

• Subsidized health plans
• dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email [e-mail] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here’s more information. Some states have required notifications. Here’s more information.

Welcome Here’s Your Smart Career Move

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Veterans Welcome!

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.