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    Compliance Administrator - Phoenix, United States - Blue Cross Blue Shield of Arizona

    Blue Cross Blue Shield of Arizona
    Blue Cross Blue Shield of Arizona Phoenix, United States

    1 week ago

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    Description


    Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.

    AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

    PURPOSE OF THE JOB


    The Compliance Administrator is responsible for tracking Medicaid Segment Arizona's overall compliance related to Medicaid Segment, DSNP and NCQA contract provisions and the submission of all contract deliverables to Regulators.

    Tracking and following up on responses to Regulator inquiries, including Administrative Reviews, audits, corrective actions and ad hoc visits. Communicating and tracking of AHCCCS public comments and memos.

    This position will be responsible for coordinating with the P&P coordinator to ensure all relevant policies have been updated prior to the policy effective date as required by the Medicaid Segment and Medicare contracts.

    This position will be responsible for producing data reports on a recurring or ad hoc basis.

    QUALIFICATIONS

    REQUIRED QUALIFICATIONS


    • Required Work Experience
    • 1 year of managed care compliance experience
    • 3 years of experience in public sector service delivery, program development, management and administration
    • Required Education
    • Bachelor's Degree in Business Administration in Public Health or a related field
    • Required Licenses
    • N/A
    • Required Certifications
    • N/A
    PREFERRED QUALIFICATIONS


    • Preferred Work Experience
    • N/A
    • Preferred Education
    • Master's in Business Administration in Public Health or a related field
    • Preferred Licenses
    • N/A
    • Preferred Certifications
    • N/A
    ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES


    • Tracks and monitors progress of all recurring contract deliverables ensuring coordination and timely submission and resubmissions.
    • Tracks and monitors progress of all regulatory ad hoc inquiries and deliverables ensuring coordination and timely submission.
    • Document management including uploading and downloading of data between Medicaid Segment and regulatory agency.
    • Disseminate AHCCCS ACOM/AMPM Policy changes to stakeholders and facilitate appropriate internal policy updates.
    • Coordinates with key stakeholders review and timely public comment submissions for AHCCCS policy updates as they go up for public comment.
    • Data analysis, management and reporting on a recurring and ad hoc basis.
    • Database management and development for deliverables application, compliance application and OGA database.
    • PMMIS System access management, coordinates with AHCCCS to ensure Medicaid Segment employees obtain, maintain and revocation of access to PMMIS.
    • Contributes to executive and quality improvement processes and participates with senior staff, management and work teams to accomplish projects, goals and standards.
    • Models and promotes the core values of Medicaid Segment Arizona for which they are responsible.
    • This position requires the employee to reside in Arizona within the assigned Geographical Service Area in Greater Arizona.
    • Perform all other duties as assigned
    • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements
    COMPETENCIES

    REQUIRED COMPETENCIES


    • Required Job Skills
    • General knowledge of Medicaid Segment and Medicare
    • General knowledge of health care operations
    • Knowledge of laws, rules, regulations, policies, and legal practices related to health and behavioral health, managed care, professional practice, nonprofit corporations, employment, contracts and civil practice.
    • Demonstrated experience and expertise with successful contract management and compliance oversight.
    • Knowledge of and demonstrated ability related to contract compliance regulations associated with behavioral health care administration and managed care organizations.
    • Knowledgeable of and maintaining compliance with contract requirements as related to the job responsibilities outlined within the job description.
    • Required Professional Competencies
    • N/A
    • Required Leadership Experience and Competencies
    • N/A
    PREFERRED COMPETENCIES


    • Preferred Job Skills
    • Knowledge of HIPAA privacy regulations and rules is helpful
    • Preferred Professional Competencies
    • N/A
    • Preferred Leadership Experience and Competencies
    • N/A
    Our Commitment


    AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

    Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see If interested in this position, please apply.
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