Blue Cross and Blue Shield of Louisiana Compliance Reporting Analyst in Baton Rouge, Louisiana
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 Blue Cross.
POSITION PURPOSE :
This position is primarily responsible for administering the Centers for Medicare and Medicaid Services Medicare Secondary Payor (or “Section III”) Reporting program for Blue Cross and Blue Shield of Louisiana (BCBSLA) The MSP Compliance Manager functions as an independent and objective individual who reviews, evaluates, translates, and communicates MSP regulations and changes which affect the organization.
The position ensures these organizations remain compliant with the rules and regulations of regulatory. Serves as the BCBSLA and BMS MSP representative to CMS as well as liaison with other Managers within BCBSLA, to remain informed, as well as provides information re: any regulatory changes that could affect Medicare Secondary Payer processes.
Complies with all laws and regulations associated with duties and responsibilities.
NATURE AND SCOPE :
Position Location :
This position reports to the Director, Shared Services.
Activities of Direct Reports :
This position has no direct reports.
Necessary Contacts :
In order to effectively fulfill this position, the incumbent must be in contact with:
Various internal departments include, but are not limited to, Member Services, Provider Services, Special Accounts, BBS, IT, Network Administration, other Benefit Operations Management and staff, Medicare Coordinator of Benefits Representative (External), Enrollment & Billing, Blue Benefits Services (BBS), MSP Claims, IT, Administrative Services, Medical Management, Underwriting, Marketing, Legal, and Compliance Department staff.
Various external entities including, but not limited to, government entities such Medicare, insurance companies, all related vendors, and other Plans.
A Bachelor’s degree in Accounting, Auditing, Business Administration or related field is required. Four years of related experience may be used in lieu of a degree.
Must have four (4) years’ experience in a regulatory or insurance environment required. Experience in internal audit, preferred.
Able to interpret Medicare regulations, assess BCBSLA’s compliance, identify inter-departmental or inter-divisional changes required for compliance, explain needs and partner with staff at all levels to solve problems and alter policies and procedures to ensure compliance.
Proven track record of developing strategy and new programs is required.
Must be able to prioritize multiple responsibilities, make decisions, find solutions and work independently in order to meet aggressive deadlines, and adapt to a fast-paced, changing environment.
Proven ability to professionally direct staff, negotiate outcomes and influence all levels of staff throughout the corporation to meet internal compliance goals and federal mandates is required.
Must demonstrate verbal and communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism.
Strong interpersonal, negotiation, persuasion and diplomatic skills are required.
Must have working knowledge of relevant software (e.g., MS Word, Excel, Outlook, etc.) and related software as well as other corporate programs and applications and the ability to learn new systems.
Expert knowledge of Medicare guidance review and interpretation is required.
Demonstrated ability to analyze metrics, summarize key business information, and translate into tactical plans to individuals at all levels in the organization is required.
Familiarity with Medicare reimbursement structures is strongly preferred.
Experience with financial modeling in a healthcare context preferred.
ACCOUNTABILITIES & ESSENTIAL FUNCTIONS :
SECTION 111 REPORTING
Serves as BCBSLA resident expert and compliance liaison on Section 111 to all staff, entities, and government regulators for related compliance, reporting and training. Conducts yearly training with all pertinent resources. At all times, remains well versed in the Section 111 Guidelines as well as newly issued, regulatory requirements, CMS process changes, or MSP-related information from CMS, through independent research, self-study, and CMS-provided training.
Accountable for coordination with all Stakeholders for the submission of MSP files to CMS.
Provides guidance to BCBSLA concerning Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) issues; strives to ensure all BCBSLA and BBS groups reporting are in compliance.
Reports on and escalates exceptions to senior management and stakeholders on all issues to ensure adherence to related government regulations.
Facilitates meetings and activities associated with the MSP Section 111 Committee. Also serves as a member of this committee.
Internal Monitoring and Reporting:
Monitors BCBSLA compliance on key technical data for MMSEA Section 111 reporting.
Reviews and monitors controls on MSP-S111 related business processes, maintenance of MSP-related eligibility data, and other key business processes related to MSP.
Develops metrics and leadership reporting in coordination with the Reporting and Analytics department. Analyzes and interprets both tangible and intangible information for use in communicating both past performance and future expected performance.
Responsible for coordinating the creation and distribution of MSP scorecards, data integrity reports, and data clean-up of MSP information.
Creates and tracks metrics on all Section 111 Report Processes.
Oversight and coordination:
Oversees and coordinates medium to large scale efforts (e.g., meetings to discuss complex errors/issues, newly issued regulatory requirements from CMS impacting business or technical processes, etc.);
Communicates all regulatory changes to affected personnel throughout the organization;
Directs errors / issues requiring research by BCBSLA and BBS personnel, to the appropriate individuals (setting clear expectations of outcomes and turnaround times);
Follows up on issues through to completion to ensure that they are promptly corrected, and responses are promptly provided to the appropriate individuals (e.g., Healthscape, other BCBSLA and BBS areas);
As needed, escalates delays in responses or lack of engagement from individuals, with their managers;
Analyzes and determines if a delay is critical (potentially impacting timely reporting) and escalates to Senior Management;
Performs quality assurance validation (e.g., sampling) to ensure that the corrections made and communicated were also successfully performed in our system of record.
Provides training on Medicare Secondary Payer Guidelines and Section 111 Reporting to new employees who have been assigned to work S111 related reports.
Generates, reviews, and spots issues in external and Internal reports related to MMSEA compliance.
Works with internal or external auditing staff to coordinate efforts to provide information and answer questions related to all Medicare Compliance: MMSEA, MSA, and Medicare.
Works with stakeholders to identify any new, internal reports needed, and documents all business requirements resulting from regulatory, business process, or other changes impacting Section III processes and reporting.
BCBSLA GROUP REPORTING ON PERFORMANCE GUARANTEES
Serves as a reporting coordinator upon request for any BCBSLA Group contracts that require monitoring of Performance Guarantees to identify metrics that are at risk of penalty.
Gathers reports from various areas responsible for creation of the deliverables, reviews reports for correct reporting dates, compares information to previous reports, and sends any concerns to the report owners for additional review.
Creates Performance Guarantee Report of all metrics subject to penalty and submits to SMT on monthly basis.
Calculates any penalties due at the end of the year and submits findings to SMT.
Uploads and maintains all reports, documentation, contract information, and Business Requirements in SharePoint.
Additionally, upon Request from management for any BCBSLA Group Contract:
Gather reports from various report owners and compile all gathered reports into a Reporting Package, adding cover letters to each report summarizing the information captured in each report.
Facilitates Report Approval meetings monthly with the Report Owners and BCBSLA Management for review of each report, discussion, and approval before sending reports to the Group.
Ensures all reports are submitted to the Group within the timeframes required.
Any delays or concerns with the reports are escalated to Senior Management.
Tracks Performance Metrics to maintain a Penalty Estimate, if requested.
Works with internal auditing staff to coordinate efforts to provide information and answer questions related to monitored Group Reports and/or Penalty Estimates.
The physical demands described here are representative of those that must be met by an employee to successfully perform the accountabilities (essential functions) of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions.
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
All BCBSLA EMPLOYEES please apply through Workday Careers.
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Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
JOB CATEGORY: Insurance