About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

How Is This Role Important to Our Work?

The purpose of this position is to develop, implement, continuously monitor and improve the Medicare and/or Medicaid products. This position is responsible for managing the activities associated with a compliance program for company government products, or government products managed by a company affiliate. This position is responsible for ensuring that the oversight and operations are meeting regulatory compliance, and that new (applicable) state and federal legislation information is communicated, implemented and maintained with respect to company products and operations. In addition, this person will carry out the compliance assessment goals, assessment activity, and reporting.

A Day in the Life:

• Establish and maintain a positive working relationship with CMS /OIG and other regulatory agencies and industry leaders to identify regulatory issues that impact the Medicare/Medicaid business.
• Develop, analyze and provide feedback to processes and reports to oversee and monitor the regional activities to ensure compliance with CMS and contractual requirements.
• Work with stakeholders and vendors to educate, train, implement self-monitoring, audit and corrective action plans.
• Establish and maintain a comprehensive understanding of all new and existing laws, regulations and other requirements that impact our products and operations in order to provide guidance to analysts on contract language filings and implementation and other compliance strategies. Manage the identification, interpretation, education and implementation of Medicare Modernization Act, Medicare Managed Care Manual and CMS Monitoring Guide requirements.
• Review cross functional Polices and Procedures across the enterprise to ensure adherence to compliance requirements. Coordinate with any internal audit functions to ensure CMS required audits are completed according to regulatory requirements using assessment tools and corrective action plans. Develop and implement audit plans, self-monitoring and audit tools to monitor and track compliance.

Nice to Have:

• Bachelor's degree.

Required Skills and Experiences:

• 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• 5 years experience managing project(s) involving multiple team members and including task assignment, working with key customers (internal or external), managing team and customer relationships and managing project deliverables.
• Detailed knowledge of the U.S. Sentencing Guidelines, the development of Government Programs Compliance Plans, Medicare Advantage and Medicaid Products.
• Proven ability to work with CMS/State Regulators.
• Knowledge of Health Plan operations including claims, enrollment, sales and marketing, health services and membership. Fundamental knowledge of health insurance regulation at both federal and state levels.
• Proven experience in the development and implementation of corporate regulatory compliance and ethics programs.
• Demonstrated success in a leadership position.
• Significant training experience including program development and implementation.
• Well-developed analytical, problem-solving and communication skills.
• Business Analysis expertise and ability to translate regulatory requirements into operation.
• In depth understanding and experience in application development and submission to the Federal Government on Medicare Products, Advanced understanding of Part D regulatory requirement.

Compensation and Benefits:

Pay Range: $100,000.00 - $135,000.00 - $170,000.00 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.

Make A Difference

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.