Compliance Advisor - D-SNP
Job Description
The Compliance Advisor is responsible for performing day-to-day activities required to maintain an effective compliance program, with a specialized focus on Dual Eligible Special Needs Plans (D-SNP). This includes coordination of complex, cross-functional matters related to organizational compliance. The role involves identifying compliance risks, specific to D-SNP, developing and/or facilitating the implementation of corrective action plans, and conducts audits and compliance reviews to monitor ongoing adherence to regulatory compliance.
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.
Participate in regulatory audits and serve as the key point of contact for compliance inquiries related to D-SNP.
Provide expert compliance guidance and support to ensure adherence to all regulatory requirements for D-SNP, including federal and state laws, CMS guidelines, and Medicare Advantage standards.
Monitor operational metrics and indicators related to compliance performance and coordinates all activities related to non-financial, regulatory audits.
Develop and implement effective compliance monitoring and auditing strategies for the D-SNP program. Identify potential risks through risk assessments and ensure timely resolution.
Serve as a subject matter expert on D-SNP regulations, providing training and guidance to internal teams on compliance policies and best practices.
Support the development and implementation of corrective action plans (CAPs) as needed, ensuring continuous improvement in compliance-related processes.
Maintain awareness of industry trends and best practices, advising the organization on proactive strategies for maintaining compliance in the D-SNP regulatory environment.
May design, develop and deliver benefit booklets and contracts to meet enterprise-wide project deliverables and initiatives.
Collaborate cross-functionally with operations, legal, and clinical teams to maintain compliance with regulatory aspects of D-SNP.
When working with Medicare products, conduct oversight of compliance programs and activities of delegated entities and contractors supporting Medicare programs.
Hiring Requirements
Bachelor's degree or advanced degree (where required)
3+ years of experience specializing in D-SNP compliance or oversight
In lieu of degree, 5+ years of experience in related field.
Preferred Skills
Direct project management experience.
Direct experience in regulatory rule analysis is strongly preferred.
Direct experience in consultative/advisory role is strongly preferred.
Ability to think creatively and strategically while handling difficult and complex issues.
Ability to work effectively and partner with varied business areas to solve business problems.
Ability to work independently.
Ability to successfully work on multiple priorities/projects within established time frames.
Ability to set priorities and adapt to changing business needs.
Strong research and analytical skills.
Effective oral and written communication and presentation skills.
Strong PC and Microsoft Office skills (MS Word, Excel, MS Project, Visio and PowerPoint).
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.
$61,900.00 - $99,000.00
Apply Now
The Compliance Advisor is responsible for performing day-to-day activities required to maintain an effective compliance program, with a specialized focus on Dual Eligible Special Needs Plans (D-SNP). This includes coordination of complex, cross-functional matters related to organizational compliance. The role involves identifying compliance risks, specific to D-SNP, developing and/or facilitating the implementation of corrective action plans, and conducts audits and compliance reviews to monitor ongoing adherence to regulatory compliance.
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.
Participate in regulatory audits and serve as the key point of contact for compliance inquiries related to D-SNP.
Provide expert compliance guidance and support to ensure adherence to all regulatory requirements for D-SNP, including federal and state laws, CMS guidelines, and Medicare Advantage standards.
Monitor operational metrics and indicators related to compliance performance and coordinates all activities related to non-financial, regulatory audits.
Develop and implement effective compliance monitoring and auditing strategies for the D-SNP program. Identify potential risks through risk assessments and ensure timely resolution.
Serve as a subject matter expert on D-SNP regulations, providing training and guidance to internal teams on compliance policies and best practices.
Support the development and implementation of corrective action plans (CAPs) as needed, ensuring continuous improvement in compliance-related processes.
Maintain awareness of industry trends and best practices, advising the organization on proactive strategies for maintaining compliance in the D-SNP regulatory environment.
May design, develop and deliver benefit booklets and contracts to meet enterprise-wide project deliverables and initiatives.
Collaborate cross-functionally with operations, legal, and clinical teams to maintain compliance with regulatory aspects of D-SNP.
When working with Medicare products, conduct oversight of compliance programs and activities of delegated entities and contractors supporting Medicare programs.
Hiring Requirements
Bachelor's degree or advanced degree (where required)
3+ years of experience specializing in D-SNP compliance or oversight
In lieu of degree, 5+ years of experience in related field.
Preferred Skills
Direct project management experience.
Direct experience in regulatory rule analysis is strongly preferred.
Direct experience in consultative/advisory role is strongly preferred.
Ability to think creatively and strategically while handling difficult and complex issues.
Ability to work effectively and partner with varied business areas to solve business problems.
Ability to work independently.
Ability to successfully work on multiple priorities/projects within established time frames.
Ability to set priorities and adapt to changing business needs.
Strong research and analytical skills.
Effective oral and written communication and presentation skills.
Strong PC and Microsoft Office skills (MS Word, Excel, MS Project, Visio and PowerPoint).
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.
$61,900.00 - $99,000.00
Apply Now