Senior Compliance Consultant

Bcbsla; Baton Rouge (LA); On-site; USD 70,000 - 100,000; Full time

Job summary

Blue Cross and Blue Shield of Louisiana (Louisiana Blue) seeks a Compliance Specialist to conduct audits ensuring adherence to laws, policies, and external requirements. The role involves coordinating with internal departments and external agencies, and advising on regulatory changes to strengthen internal controls.

The position requires strong analytical and communication skills, confidentiality, and the ability to work with cross-functional teams.

Qualifications

• Bachelor’s degree required; four years in audit/analytical compliance role preferred.
• Experience with Medicare/Medicaid or health care reform compliance preferred.
• Strong written and oral communication; ability to handle confidential information.

Responsibilities

• Conduct audits, reviews, and evaluations to assess compliance with laws and internal policies.
• Support external audits and regulatory examinations; coordinate with management and auditors.
• Advise management on changes to laws and regulations and maintain up-to-date compliance records.
• Provide training and education on compliance programs to company employees.

Skills

Auditing

Regulatory knowledge

Analytical ability

Communication skills

Confidentiality

Education

Bachelor’s in Business Administration or Health Administration

Master’s in related field preferred

Tools

Microsoft Office

Job description

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 PURPOSE

Responsible 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.

QUALIFICATIONS

Education 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 Functions

The 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

Company Mission

To improve the health and lives of Louisianians.

Company Vision

A better state of health through preventative, easier and more affordable healthcare.

Blue Cross and Blue Shield of Louisiana (Louisiana Blue) is incorporated as Louisiana Health Service & Indemnity company and is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross and Blue Shield of Louisiana is licensed to sell products only in the state of Louisiana.