[Hiring] Senior Compliance & Ethics Analyst @CareFirst

Role Description

The Senior Ethics & Compliance Analyst will support the organization's ethics and compliance and its defined Ethics & Compliance Program. This position will ensure the implementation and maintenance of the annual Compliance Workplan for the organization while providing review and analysis of regulatory rules/guidelines, monitoring the organization's compliance performance, tracking Key Performance Indicators (KPIs)/Key Risk Indicators (KRIs), and supporting Program Integrity and Fraud, Waste, and Abuse (FWA) efforts. The position will also monitor Corrective Action Plans (CAPs) established to address identified compliance issues and perform post-evaluation procedures for compliance implementation and remediation activities.

• Collaborates with business owners to establish and monitor action plans to address remediation of compliance risks.
• Ensures that root cause analyses are performed to address underlying issues when action plans are needed.
• Follows up with stakeholders to ensure remediation efforts are on track, successful, and validate that action plans have been implemented correctly.
• Regularly monitors CAPs implementation and communicates risks associated with identified control deficiencies to stakeholders.
• Provides reporting to the Ethics & Compliance leadership, documenting CAPs results, escalating risks and issues related to identification, implementation, and remediation.
• Monitors compliance performance based on Compliance Risk Assessments to provide oversight.
• Reviews, analyzes, and distributes regulatory rules, guidelines, and contractual requirements to educate impacted CareFirst business areas and delegated entities.
• Identifies and tracks required actions as the result of regulatory rules, guidelines, and contractual requirements.
• Tracks and assesses KPIs and KRIs.
• Identifies compliance risks by gathering, reviewing, and analyzing organizational data for downward trends or instances of non-compliance or potential non-compliance.
• Establishes, validates, and implements FWA safeguards for enrollee communications, excluded, sanctioned, or precluded providers, employees, enrollees, and entities.
• Ensures consistent review of required government exclusion lists.
• Conducts investigations, research, and due diligence to address compliance incidents, events, inquiries, and leadership concerns.
• Performs proactive and concurrent risk assessments to identify compliance risks associated with incidents, events, or company initiatives.
• Prepares clear, professional, and audit-ready responses to originating parties, ensuring timely resolution, complete and accurate answers, and adherence to member privacy requirements.
• Supports and drives the continued maturity of CareFirst compliance through ongoing education, development of compliance tools, initiatives, and collaboration with other related risk functions.
• Supports the development, implementation, and maintenance of written policies and procedures.
• Collaborates and contributes to Company standards of conduct.
• Supports the maintenance of required Compliance committees.
• Monitors that all necessary parties receive effective training and education as well as supporting third-party onboarding and annual attestation processes.
• Assists with the performance of post-implementation procedures to validate performance of compliance requirements resulting from mandates, regulatory and contractual changes, systems, or partner implementations.
• Conducts compliance review of prospective and current member materials against regulatory, contractual, Company, and BlueCross BlueShield Association (BCBSA) requirements.
• Prepares and submits to regulators as applicable.

Qualifications

• Education Level: Bachelor's Degree.
• Licenses/Certifications within 1 Year Preferred:
  • CHC - Certified Healthcare Compliance
  • Certified Compliance & Ethics Professional (CCEP)
• Experience: 5 years knowledge of ethical, corporate compliance with demonstrated ability to apply elements of the Federal Sentencing Guidelines for organizations and experience with compliance and/or regulatory or legal programs.
• Preferred Qualifications:
  • Experience in an operational capacity in the health care or health care insurance industry.
  • Professional certification such as:
    • Certified in Healthcare Compliance (CHC)
    • Certified Compliance Professional (CCP) by Health Ethics Trust
    • Certified Compliance and Ethics Professional (CCEP)
• Knowledge, Skills and Abilities (KSAs):
  • Knowledge of compliance program development and maintenance.
  • Strong research and analytical skills.
  • Ability to work on multiple projects and shift priorities.
  • Proficient in Microsoft Office applications.
  • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers.
  • Must be able to effectively communicate and provide positive customer service to every internal and external customer.

Requirements

• Salary Range: $71,496 - $141,999
• Sponsorship in US: Must be eligible to work in the U.S. without Sponsorship

Benefits

• CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Company Description

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.