What are the responsibilities and job description for the Compliance Advisor - Medicare Appeals position at NC Health Affiliates LLC DBA Blue Cross NC?
Job Description The Compliance Advisor is responsible for performing day-to-day activities required to maintain an effective compliance program, including the coordination of complex, cross-functional matters related to organizational compliance. Identifies compliance risks, develops and/or facilitates implementation of corrective action plans and conducts audits/compliance reviews to monitor ongoing compliance. 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 Learn more 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. $60,907.00 - $97,452.00 Skills About Us It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re 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. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. 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. Authorization to Work in the United States We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview for English or Visión General de E-Verify for Español. Request Accommodations Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at HR.Staffing@bcbsnc.com. For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming
Salary : $60,907 - $97,452