Description
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
This position is responsible for auditing operations compliance with accreditation and regulatory requirements in assigned areas. Ensuring compliance with Plan, BCBSA, NCQA and State and Federal requirements. Researching and reporting monthly on trends. This will include monthly documented summaries, receipts, and how these impact accreditation requirements. Recommending and implementing technical solutions (i.e. Enterprise Appeals Application requirements) and communicating to the management team of the need/gap. Gathering data, analyzing data, and preparing reports including disseminating information from various sources and systems. Supporting projects and initiatives and resolving issues by working with staff within the department or across departments.Required Job Qualifications:
- Bachelor's degree and 2 years of insurance experience OR 6 years' insurance experience. Knowledge of health care regulatory and legislative process; experience reading and interpreting legislation.
- Knowledge or experience reviewing accreditation standards and evaluating level of compliance, identifying challenges and proposing solutions
- Knowledge or experience monitoring compliance and managing evidence documents.
- Experience preparing monthly reports and forecasting.
- Research and analytical skills.
- Detail orientation and organizational skills; experience meeting deadlines on time.
- Clear and concise verbal and written communication skills.
- PC proficiency to include Word, Access, Excel and Cognos.
Preferred Job Qualifications:
- Audit experience and knowledge of Accreditation (i.e. NCQA, URAC, etc.)
- Knowledge and experience in advance Microsoft data analytical skills
- Knowledge or experience in enterprise PDM business rules
- Knowledge or experience in NOSD internal systems (PPW, CAQH, Salesforce)
- Ability to handle multiple projects in an environment of urgent and shifting deadlines.
#LI-Hybrid
#LI-AS1
Compensation: $40,900.00 - $91,000.00
Exact compensation may vary based on skills, experience, and location
HCSC Employment Statement:
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
To learn more about available benefits, please click https://careers.hcsc.com/totalrewards
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