Compliance Specialist I

Blue Cross of Idaho•Meridian, ID

6d•Onsite

About The Position

Blue Cross of Idaho is seeking a Compliance Specialist to be a part of our Provider Operations team. This role will be responsible for ensuring compliance with regulatory guidance, contractual obligations and vendor arrangements.

Requirements

4 years’ health industry, internal audit, legal, vendor management, compliance, or government programs experience
Bachelor’s Degree or equivalent work experience (Two years’ relevant work experience is equivalent to one-year college)

Responsibilities

Establish delegation processes and protocols with both delegates and vendors; to ensure processes, policies and documentation are fully compliant and audit ready
Implement reporting standards and expectations with both delegates and vendors
Lead business review meetings with both delegates and vendors
Lead operational process meetings with colleagues across the entire organization
Maintain and apply knowledge of regulations and regulatory changes relevant to the industry and to the organization.
Manage the collection and submission of all regulatory required reports and information requests.
Monitor areas of risk and call out concerns to leadership and/or the compliance department, as needed.
Coordinate, direct, and monitor activities across operational areas to ensure compliant processes and procedures.
Identify opportunities and implement process improvements, to support compliance.
Identify, facilitate, and develop specialized training needs specific to regulatory requirements
Develop audits to identify and assess areas of compliance and privacy risk.
Review complaints for regulatory compliance.
Determine root cause and implement corrective action plans.
Perform other duties and responsibilities as assigned.