Job DescriptionThe Compliance Advisor is responsible for performing day-to-day activities required to maintain an effective compliance program, including the coordination of complex, cross-functional matters related to organizational compliance. Identifies compliance risks, develops and/or facilitates implementation of corrective action plans and conducts audits/compliance reviews to monitor ongoing compliance.What You'll Do
Utilize knowledge of the compliance and regulatory field to address multifaceted compliance/regulatory questions and problems.
Collaborate with pharmacy compliance business partner on Ops-Corporate Compliance issues.
Contribute to the planning, implementation, and execution of pharmacy-related projects within the organization.
Coordinate stakeholder communication and engagement throughout the project lifecycle, providing regular updates and addressing concerns specific to Market Conduct Annual Statement (MCAS), Prescription Drug Data Collections (RxDC), and Qualified Health Plan (QHP) Readiness reports.
Pharmacy records requests (research, case and claims retrieval for documentation submission).
Serve as a resource for pharmacy-related initiatives, providing guidance and support to team members as needed.
Research, investigate and evaluate compliance implementation initiatives and required remediation initiatives.
Provide support to business areas by analyzing and recommending effective solutions to compliance issues to best meet business needs.
Ensure overall compliance with new and existing laws, regulations, obligations, Medicare guidance and/or bid requirements as required of the Compliance Department
Monitor operational metrics and indicators related to compliance performance and coordinates all activities related to non-financial, regulatory audits.
Conduct risk assessments and/or audits and monitor business systems for compliance. Assure appropriate implementation and/or corrective action is taken to address risks and issues identified.
Analyze and assess environment and compliance program needs. Recommend compliance programming and compliance initiatives to meet those needs.
Develop and implement training and other communications for employees and external entities (e.g., producers and vendors).
Perform review of operational policies for compliance and provide feedback to business areas.
May design, develop and deliver benefit booklets and contracts to meet enterprise-wide project deliverables and initiatives.
May perform compliance reviews of marketing materials for commercial and/or Medicare lines of business.
When working with Medicare products, conduct oversight of compliance programs and activities of delegated entities and contractors supporting Medicare programs.
What You'll Bring (Hiring Requirements)
Bachelor's degree or advanced degree (where required)
3+ years of experience in related field.
In lieu of degree, 5+ years of experience in related field.
Demonstrated medical and pharmacy drug end-to-end audit experience.
Knowledge with interpreting regulatory and compliance statutes.
Salary Range$55,800.00 - $89,300.00About UsIt's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.Authorization to Work in the United StatesWe use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (https://www.e-verify.gov/employees/e-verify-overview) for English or Visión General de E-Verify (https://www.e-verify.gov/es/empleados/vision-general-de-e-verify) for Español.For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and WyomingMuch more than a paycheckThe total value of working at Blue Cross NC goes far beyond your paycheck. We offer benefits and perks (https://careers.bluecrossnc.com/global/en/benefits) that help you thrive, such as competitive health benefits, bonus plans based on performance, 401(k) with employer match, paid time off (plus two well-being days), and a variety of career development and wellness programs.