Sr. Div Compliance Consultant
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POST DATE 9/13/2016
END DATE 10/11/2016
Blue Cross and Blue Shield of North Carolina
Winston Salem, NC
JOB DESCRIPTIONJob Description:
Job Description Ensure departmental/divisional compliance with existing laws, regulations and requirements by leading and supporting multifaceted and more complex cross functional activities that may impact a range of critical business processes aligned directly to key strategic initiatives. Develop project plans and recommendations in support of Departmental/Divisional compliance objectives and leads implementation; tracks and reports on the status of the project. Propose a variety of solutions to business issues/problems utilizing appropriate analysis tools (i.e. Cost/Benefit Analysis, Flowcharting, etc.). Evaluate project risks, developing contingency plans and responding to change in risk as the project progresses. Develop and tracks budgets, operating plans and financial cost forecasts to support the objectives of the project. Collaborates closely with division team members, business owners, sponsors, and partners in the analysis, design, development, implementation, and operational support of system/process enhancements and configurations to ensure quality, cost effectiveness, timeliness of customer service, and regulatory requirements and mandates are met. Conduct more complex risk assessments and/or audits and monitor department/divisional systems for compliance. Ensure appropriate implementation and/or corrective action is taken to address risks and issues identified in partnership with Corporate Compliance. Lead the analysis and assessment of the departmental environment and recommend remediation initiatives and/or compliance programming in consultation with Corporate Compliance. Perform review of operational policies for compliance with state/federal laws and regulations and/or process improvements/efficiencies as needed. Ensures that necessary controls are in place to monitor the effects of new functionality, and communicates status and changes to affected parties. Manage and/or facilitate departmental/divisional implementation and remediation of compliance initiatives in conjunction with Corporate Compliance. Develop and implement training and other communications for department personnel as needed When working with Medicare products, coordinates departmental/divisional oversight of compliance programs and activities under the oversight of the Corporate delegated entities supporting Medicare programs. May serve as privacy coordinator for CRPI, first point of contact and provide subject matter expertise for privacy related questions. Develop and implement corrective action plans to address identified privacy issues. May directly supervise and/or coach/mentor more junior team members and review work as needed. Hiring Requirements Bachelor s Degree and 7 years work experience in health insurance, health care, compliance or regulatory affairs that provides the candidate with strong knowledge of health care regulations and products. If advanced degree is held, 5 years work experience as stated above. If no degree, 9 years work experience as stated above. Direct project management experience with larger and more complex projects is required. For role focused on Medicare, experience and expertise with Medicare managed care products required. Hiring Preferences Advanced degree in health care administration, business or law Ability to successfully lead and manage multiple projects/priorities within established time frames Excellent project management skills with ability to set priorities and adapt to changing business needs. Excellent analytical, planning and problem-solving skills. Ability to successfully interface with individuals at all levels, including top management, both internal and external. Ability to make concise, independent and defensible decisions in often high-pressure situations. Strong oral and written communication and presentation skills Ability to be discreet and diplomatic. Strong PC and Microsoft Office skills (MS Word, Excel, MS Project, Visio and PowerPoint) Project Management Professional (PMP) certification preferred
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina. Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We are committed to better health and better health care in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.
Our company is a not-for-profit with headquarters in Durham and major operations in Winston-Salem and Fayetteville. In all we employ more than 4,500 North Carolinians and serve more than 3.7 million customers.
Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.