Senior Compliance Consultant

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.

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.

This role does not manage people. This job reports to:
Departmental Leadership.

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.

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.

Position requires strong human relation skills in addition to analytical ability. Also, strong communication skills both written and oral.…