About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming health care. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

How Is This Role Important to Our Work?

This position is responsible for ensuring that Medical Affairs and IHM operations are in accreditation, regulatory, legal and contract compliance, and that these and other requirements are communicated, implemented and monitored.

A Day in the Life:

• Monitors and analyzes new and modified accreditation standards, state and federal laws, regulations, and contract developments impacting IHM and Medical Affairs operations to determine impact on current operations and work flows.
• Researches compliance impact and communicates new requirements and recommendations to management.
• Develops and maintains IHM policies and procedures to support compliance with applicable laws and accreditation standards.
• Monitors key business processes to ensure compliance, develops compliance reports and other process improvement documents, and presents reports, trends and recommendations to key stakeholders.
• Provides guidance and training to IHM and Medical Affairs staff regarding new and existing statutory, regulatory, legal, accreditation, and other requirements affecting operations.
• Serves as subject matter expert for commercial lines of business.
• Responds to inquiries from internal and external auditors, including documentation and audit file preparation.
• Assists in implementation of audit plans, internal assessments, and other activities to monitor and track compliance involving multiple areas and/or departments in Blue Cross.
• Represents Compliance in process improvement and policy committees as well as other cross functional committees as needed.
• Independently lead cross functional meetings as needed.
• Assist with NCQA standard coordination and documentation.
• Ad hoc project management and/or other responsibilities as needed by management.

Nice to Have:

• Bachelor's degree.
• Experience in regulatory, compliance or managed care.
• Experience with DHS, MDHS, CMS Technical Specifications for audit readiness
• Clinical degree or years of experience in working in clinical setting Government, regulatory, or health care compliance combined with experience in managed care-utilization management experience.
• Demonstrated experience with policy development, formal writing, and reporting.
• Demonstrated experience with: Conducting audits, Tracking results, Communicating results of audits to stakeholders, Developing action plans based on audit findings.
• Project management experience.

Required Skills and Experiences:

• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Ability to work collaboratively across departments.
• Ability to manage work and projects independently.
• Excellent verbal and written communication and presentation skills, with ability to express complex concepts into simple terms and ability to write clear, concise, and grammatically correct materials.
• Ability to analyze data. Strong problem-solving and critical thinking skills.
• Proficient level of Microsoft Office suite required (e.g. Word, Excel, PowerPoint and Access).
• Recent experience designing and populating databases, which includes download, upload and formatting data.

Compensation and Benefits:

Pay Range: $77,200.00 - $102,300.00 - $127,400.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

To discover more about what we have to offer, please review our benefits page.

Equal Employment Opportunity Statement

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.