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Project Consultant - Regulatory Oversight in Southfield, MI at AF Group

Date Posted: 6/22/2018

Job Snapshot

Job Description

COBX- Senior Health Services







SUMMARY:



Regulatory Oversight Project Consultants are responsible for leading processes and projects that ensure effective oversight and ongoing monitoring of Blue Cross Blue Shield of Michigan (BCBSM) Medicare Advantage and Part D programs. This position's responsibilities include ensuring consistency in business practices and monitoring compliance with regulatory requirements for Medicare Advantage operations. This role develops and improves workflows and business processes to strengthen controls, mitigate risks, and improve quality and efficiency. Interface with external customers, including regulatory agencies and professional associations, internal customers and vendors to identify and/or analyze business problems and develop solutions is required.



RESPONSIBILITIES/TASKS:




  • Identify, analyze, and develop solutions to assist in the identification and mitigation of compliance risks and strengthen controls.
  • Act as CMS liaison to BCBSM
  • Research and interpret CMS regulations for business areas
  • Draft communications for executive leadership, CMS regulators, and internal departments
  • Coordinate and submit attestations to CMS on behalf of BCBSM.
  • Participate in government audits, review, and reporting activities; includes providing a first level review on all performance and CMS data validation audits.
  • Track and manage corrective action plans to address identified compliance risks and deficiencies.
  • Collect and review evidence from vendors (FDR) to support MA compliance requirements
  • Maintain integrity of MA policy and procedure repository, ensuring that all policies are reviewed and approved annually
  • Chair and participate in focused project workgroups
  • Develop expertise in Regulatory Oversight processes to foster continuous improvement of core processes.
  • Interface with various departments, senior management, and individuals external to BCBSM providing expertise in compliance and regulatory issues and initiatives
  • Represent leadership staff at meetings in their absence.
  • May have supervisory responsibilities as required.
  • Ensure expectations are developed, controlled, and executed in a timely manner.

    This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.





    EMPLOYMENT QUALIFICATIONS:





    EDUCATION:



    Bachelor's degree in a related field. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required.



    EXPERIENCE:



    Five years of experience in a related field. Leadership and/or analytical experience preferred.



    SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:




  • Excellent analytical, organizational, problem solving, and verbal and written communication skills.
  • Significant creativity and flexibility.
  • Ability to work and communicate with regulatory bodies and professional associations.
  • Ability to work independently, within a team environment, in a leadership role, and with multiple priorities/deadlines.
  • Proficient in current industry standard PC applications and systems (e.g., Access, Excel and Word).
  • Ability to develop, implement, and monitor policies and procedures.



    WORKING CONDITIONS:



    Work is performed in an office setting with no unusual hazards. Occasional travel may be required.

    The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

    We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.

    Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
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