Bus Unit Compliance Liaison
Blue Cross Blue Shield of Michigan

Job Info

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This position will be responsible for monitoring compliance with the Patient Protection and Affordable Care Act (PPACA), HIPAA Privacy and Security, National Committee for Quality Assurance (NCQA) accreditation, Health Information Trust Alliance (HITRUST), Centers for Medicare and Medicaid Services (CMS), state mandates, regulations, and for ensuring that the operational areas develop controls, identify and implement methods to monitor, complete documentation, and handle additional relevant tasks for internal employees, as well as business partners/vendors who support Service Operations.

• Assesses accreditation / regulatory impacts to business unit, including business unit's business partners/vendors; partners with area leadership to develop and implement strategy for compliance with regulations. Coordinates and reports on regularly scheduled and as-needed compliance self-assessments. Validates business self-monitoring results.
• Manages audits for the division. Single point of contact for General Audit, regarding both internal and customer audits. Assists the business in preparation for audits. Collaborates with other departments to direct compliance issues to appropriate channels for resolution.
• Reviews policies and procedures annually to assure accountability to the standards and processes defined by management. Recommends and drafts updates based on changed or new requirements.
• Coordinates the implementation and reporting of the CAP progress. Identifies trends and/or potential areas of compliance vulnerability and risk, partners with area leadership to develop and implement strategies to mitigate risks.
• Responsible for the escalation and resolution of HIPAA Privacy & Security and vendor compliance issues to the appropriate management personnel.
• Tracks to ensure enforcement and adherence to policies. Documents exceptions for management. Updates and publishes the consolidated monthly compliance scorecard. Coordinates the administration of the MetricStream eGRC too.
• Coordinates and reports on New Hire and annual compliance training: (a) annual training, and (b) additional training resulting from P&P updates, regulations, CAPs, etc.
• Communicates compliance-related information to the business area.
  Responsible for oversight of annual vendor attestations in accordance with CMS and PPACA requirements for BCBSM and/or BCN including; developing plan/schedule to review and submitting documents to Emerging Markets and Corporate Compliance.
• Acts as consultant to provide education and guidance to Contract Administrator, BCN Compliance Liaison and business partners/vendors regarding vendor compliance activities including; changes to compliance requirements initiated by Federal regulations (CMS, ACA), BCBSM and BCN.
• Represents departmental leadership at executive-level meetings.
• Position may have one or more direct reports.
  

"Qualifications"

• Bachelor's Degree in related field required. Master's degree preferred.
• Five years of experience in related health care field, which may include experience in technical/systems, information security, compliance and/or audit risk assessment.
• Specific training in risk assessment, audit techniques preferred.
• Working knowledge of NCQA accreditation requirements, or federal regulations related to health care reform, or advanced knowledge of risk assessment concepts and generally accepted auditing principles.
• Excellent documentation skills, using the MS Office suite of tools.
• Ability to plan, organize, direct and control projects while exercising high ethical standards and good judgment.
• Excellent analytical, organizational, interpersonal, problem solving, written and verbal communication skills, as well as the ability to apply concepts to practical situations.
• Excellent consultative skills and ability to interface with all employees at all levels including senior leadership. Leadership/supervisory experience preferred.
• Ability to deliver sensitive communications to leadership.
• Excellent time management skills.
• Ability to work independently and with minimal supervision.
• Ability to travel in-state and out-of-state.

Departmental Preferences:

• Microsoft Teams and SharePoint admin experience is preferred.
• Experience with NCQA submission experience is preferred.
• Experience developing performance reporting experience is preferred.
• Great organization skills and attention to detail experience is preferred.

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.

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