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Blue Cross Blue Shield of Minnesota Medical Affairs Compliance Analyst Sr Job in Eagan, Minnesota

About Blue Cross At Blue Cross and Blue Shield of Minnesota, we are developing industry-leading strategies every day that make a healthy difference in people's lives. Blue Cross has a legacy of improving health through innovation because we believe that everyone should have the opportunity to live the healthiest life possible. Chartered in 1933 as the state's first health plan, we've been serving the health care needs of Minnesotans for more than 80 years. Blue Cross supports you with competitive pay and a comprehensive benefits package. Many Employee Resource Groups are active in the company, promoting inclusion and helping us meet the diverse needs of our workforce and our members. Join us, and enjoy a work environment where all employees are respected and valued - a workplace honored with a perfect score on the Human Rights Campaign Corporate Equality Index for 2017. Find your place at a company that cares. Description Summary This position is responsible for ensuring that Medical Affairs and IHM operations are in accreditation, regulatory, legal and contract compliance, and that these and other requirements are communicated, implemented and monitored. Accountabilities Monitors and analyzes new and modified accreditation standards, state and federal laws, regulations, and contract developments impacting IHM and Medical Affairs operations to determine impact on current operations and work flows. Researches compliance impact and communicates new requirementsand recommendations to management. Develops and maintains IHM policies and procedures to support compliance with applicable laws and accreditation standards. Monitors key business processes to ensure compliance, develops compliance reports and other process improvement documents, and presents reports, trends and recommendations to key stakeholders. Provides guidance and training to IHM and Medical Affairs staff regarding new and existing statutory, regulatory, legal, accreditation, and other requirementsaffecting operations. Serves as subject matter expert for commercial lines of business. Responds to inquiries from internal and external auditors, including documentation and audit file preparation. Assists in implementation of audit plans, internal assessments, and other activities to monitor and track compliance involving multiple areas and/or departments in Blue Cross. Represents Compliance in process improvement and policy committees as well as other cross functional committees as needed. Independently lead cross functional meetings as needed. Assist with NCQA standard coordination and documentation. Ad hoc project management and/or other responsibilities as needed by management. Requirements Bachelor's degree required in healthcare or related field and 5 years of related work experience, or 8 years of related work experience in lieu of a degree. Ability to work collaboratively across departments. Ability to manage work and projects independently. Excellent verbal and written communication and presentation skills, with ability to express complex concepts into simple terms and ability to write clear, concise, and grammatically correct materials. Ability to analyze data. Strong problem-solving and critical thinking skills. Proficient level of Microsoft Office suite required (e.g. Word, Excel, PowerPoint and Access); recent experience designing and populating databases, which includes download, upload and formatting data. Preferred Requirements Experience in regulatory, compliance or managed care preferred. Clinical degree or years of experience in working in clinical setting. Government, regulatory, or health care compliance combined with experience in managed care-utilization management experience. Demonstrated experience with policy development, formal writing, and reporting. Demonstrated experience with: Conducting audits. Tracking results. Communicating results of audits to stakeholders. Developing action plans based on a


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