Blue Cross and Blue Shield of Louisiana Jobs

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Blue Cross and Blue Shield of Louisiana Mgr, Medicare Compl Programs 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.

Please note that effective Jan. 4, 2022, Blue Cross and Blue Shield of Louisiana will require any employee who enters any of our offices or who interacts in person with anyone for company business purposes to be fully vaccinated for COVID‑19, unless legally entitled to a reasonable accommodation related to religious or medical exemptions. Please note this is subject to change at any point in time to ensure compliance with company policy or government mandates.

Residency in or relocation to Louisiana is preferred for all positions.

POSITION PURPOSE

Oversees compliance with all applicable Medicare laws, regulations, and guidance; the Medicare Compliance program and related company policies and procedures. Oversees day-to-day Medicare compliance activities to ensure operations are compliant with CMS requirements. Oversees internal program focused on detecting, investigating and preventing compliance violations of the Medicare program and external laws and regulations to which the organization is subject. Manages the development and maintenance of Medicare compliance databases and files. Maintains accountability for complying with all laws and regulations that are associated with duties and responsibilities.

NATURE AND SCOPE

  • Manages People

  • This role directly manages 3 workers

  • This role directly manages these jobs: ASSOCIATE COMPLIANCE CONSULTANT;COMPLIANCE CONSULTANT;SENIOR COMPLIANCE CONSULTANT

  • This role reports to this job: Director, Medicare Advantage Compliance & Medicare Compliance Officer

  • Necessary Contacts: To do this job effectively the incumbent has to be in contact with: BCBSLA Leadership, all Medicare operational departments, district offices, and all employees; Blue Cross Blue Shield Association (BCBSA); Centers for Medicare and Medicaid Services (CMS); other governmental agencies; producers and consultants.

QUALIFICATIONS

Education

  • Bachelor's Business Administration, Hospital Administration or related field required

  • Master's in related field preferred

  • Four years of related experience can be used in lieu of a Bachelor’s degree.

Work Experience

  • 5 years of audit or compliance experience and should include supporting and enforcing a corporate compliance program required

  • 2 years of leadership experience required

  • Experience in Governmental Compliance (MA, MAPD, PDP, HCR, Medicaid), and a thorough understanding of regulatory issues and laws is required and two years of supervisory experience preferred.

Skills and Abilities

  • Competency in strategic planning, training, negotiation, facilitation, and project development.

  • Excellent organizational and conceptual skills are necessary.

  • Must be able to work independently, work extended hours, handle multiple priorities concurrently and maintain confidentiality.

  • Must be computer literate with working knowledge of personal computer and leading software packages.

Licenses and Certifications

  • Certification as a CIA or a CPA required

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

  • Manages the activities of the Medicare Compliance program to include, but are not limited to, performing reviews, evaluations, research, training, awareness activities, monitoring and other related tasks by staying abreast of all applicable Medicare laws, regulations, and guidance to determine, facilitate and ensure the Company and its employees are effectively compliant.

  • Advises management on compliance issues related to Medicare operations, services, regulations and laws to enable them to fulfill their duties by providing regular Medicare Compliance updates and/or reports to the Director and VP (as needed).

  • Ensures the Medicare Compliance program and all related activities, including but not limited to, policies, training, investigating and reviewing areas of Medicare vulnerability in company procedures or policies demonstrated by detected offenses or identified in comments from employees comply with CMS requirements.

  • Ensures distribution of the Code of Business Conduct and Medicare policies to all employees associated with the Medicare program, required third party contractors (FDR’s) who perform services for or on behalf of the Company and to vendors who conduct significant business with the Company direction. This is done in accordance with the Federal Sentencing Guidelines, Chapter 21 of the Medicare Managed Care Manual, and CMS FWA guidelines and the Company’s Compliance and Ethics program. Part of this is done during on-site audits at FDR’s.

  • Serves as the main point of contact and facilitates productive relationships with CMS personnel and manages the coordination of CMS and other regulatory audits of the MAPD plan.

  • Oversees the Medicare Compliance program by maintaining fully compliant processes as stipulated by CMS, including managing Medicare compliance staff, identifying risks to the Company of non-compliance, designing compliance review schedules to mitigate such risks, developing and delivering required training, and reporting to the Medicare Compliance Committee and Management, while preparing reports for the Compliance Audit Committees about this activity to ensure Medicare compliance.

  • Accountable for hiring, developing, and coaching direct reports, as well as, for disciplinary action, if necessary. Conducts and documents performance reviews of direct reports with input from the Director.

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.

#LI_RF1

An Equal Opportunity Employer

All BCBSLA EMPLOYEES please apply through Workday Careers.

PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)

Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

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: Legal, Compliance & Audit

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