Compliance Advisor - Medicare Appeals

Job Description

What You'll Do

• Utilize knowledge of the compliance and regulatory field to address multifaceted compliance/regulatory questions and problems.
• Research, investigate and evaluate compliance implementation initiatives and required remediation initiatives.
• Provide support to business areas by analyzing and recommending effective solutions to compliance issues to best meet business needs.
• Ensure overall compliance with new and existing laws, regulations, obligations, Medicare guidance and/or bid requirements as required of the Compliance Department
• Monitor operational metrics and indicators related to compliance performance and coordinates all activities related to non-financial, regulatory audits.
• Conduct risk assessments and/or audits and monitor business systems for compliance. Assure appropriate implementation and/or corrective action is taken to address risks and issues identified.
• Analyze and assess environment and compliance program needs. Recommend compliance programming and compliance initiatives to meet those needs.
• Develop and implement training and other communications for employees and external entities (e.g., producers and vendors).
• Perform review of operational policies for compliance and provide feedback to business areas.
• May design, develop and deliver benefit booklets and contracts to meet enterprise-wide project deliverables and initiatives.
• May perform compliance reviews of marketing materials for commercial and/or Medicare lines of business.
• When working with Medicare products, conduct oversight of compliance programs and activities of delegated entities and contractors supporting Medicare programs.

What You'll Bring

• Bachelor's degree or advanced degree (where required)
• 3+ years of experience in related field
• In lieu of degree, 5+ years of experience in related field

What You'll Get

• The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community

• Work-life balance, flexibility, and the autonomy to do great work

• Medical, dental, and vision coverage along with numerous health and wellness programs

• Parental leave and support plus adoption and surrogacy assistance

• Career development programs and tuition reimbursement for continued education

• 401k match including an annual company contribution

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Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

Skills