Medicare Advantage Compliance Program Admin.
Premera Blue Cross
 Mountlake Terrace, WA

Position Description

Join Our Team: Do Meaningful Work and Improve People's Lives

Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we're creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!

As a Medicare Advantage (MA) Compliance Program Administrator, you will responsible for working with the MA Compliance Officer in the oversight and monitoring of Premera Blue Cross' MA Compliance Program. This includes working in a complex multi-functional environment to assist operational areas throughout the Company, as well as numerous vendors, in meeting applicable federal legal and regulatory requirements in addition to ensuring adherence to corporate policies as they apply to the MA contract.

What you'll do:

  • Update MA policies and procedures for the Compliance & Ethics department.
  • Plan and conduct compliance monitoring and auditing activities of internal Premera functions as well as of vendors to verify compliance with established MA policies and regulations. This may also involve working closely with Legal on attorney-client privileged reviews to define the scope and recommend corrective action plans to improve compliance.
  • Prepare written reports to document findings, including recommendations for corrective action. Present recommendations and results of reviews to all levels of management to ensure thorough understanding of compliance requirements.
  • Follow up on findings requiring corrective action to ensure any compliance issues have been adequately and promptly resolved. Conduct additional testing as needed to ensure compliance.
  • Proactively participate in various oversight and working committees as assigned, acting as the compliance SME to ensure compliance with applicable MA requirements.
  • Remain current and knowledgeable of industry and compliance trends and the changing requirements related to MA. Educate others on those requirements and quickly conduct research, when needed, to ensure Premera remains compliant.
  • Lead assigned compliance monitoring activities such Health Plan Management System (HPMS) memo distribution, ensuring regulatory changes are tracked and implemented, ensuring HPMS access is appropriate and data maintained in HPMS is accurate, review of documents to ensure regulatory compliance, tracking potential noncompliance issues through to completion, ensuring the root cause has been identified and corrected, etc.
  • Work with executives from various business areas to ensure required Centers for Medicare and Medicaid Services (CMS) data submissions and attestations are completed accurately and by required due dates.
  • As needed, take the lead role in compiling data requests of functional areas in preparation for regulatory exams. Interact with regulators to coordinate audits and ensure regulators have what they need to conduct their work while ensuring Premera data is kept confidential.
  • Partner with other departments, as assigned, to build and enhance compliance related oversight processes.

What you'll bring:

  • Bachelor's Degree or equivalent experience.
  • Five (5) years of relevant business experience.
  • Juris Doctor (JD) preferred.
  • Medicare Advantage experience highly desired.
  • Prior pharmacy experience is a plus!
  • Certified Compliance & Ethics Professional (CCEP), Certified in Healthcare Compliance (CHC), or a Certificate in Healthcare Regulatory Compliance is preferred.
  • Experience working with government health plan programs (especially Medicare Advantage Part D), and/or experience in health care, health insurance, compliance/regulatory, or internal audit.
  • Strong knowledge of regulatory and legislative process.
  • Proven ability to analyze and evaluate legal and regulatory requirements.
  • Strong interpersonal, written and presentation skills with ability to communicate, regulatory information in an accurate and easily understandable manner to all levels of employees.
  • Proven ability to successfully negotiate and influence without authority in difficult situations.
  • Proven and effective problem-solving and decision-making skills.
  • Excellent organization skills and the ability to successfully manage multiple projects through to completion at the same time.

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What we offer

  • Medical, vision and dental coverage
  • Life and disability insurance
  • Retirement programs (401K employer match and pension plan)
  • Wellness incentives, onsite services, a discount program and more
  • Tuition assistance for undergraduate and graduate degrees
  • Generous Paid Time Off to reenergize
  • Free parking

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.