Accreditation & Compliance Manager

Logistics:

This position is located at our Percival Rd location in Columbia, SC, with the opportunity for remote/hybrid schedule. This is a full time position, 40 hours per week/8 hours per day, Monday-Friday.

What You'll Do:

• Oversees accreditation compliance to include interpretation of the standards, monitoring of multiple areas' compliance, as well as implementing quality improvement activities to improve compliance.

• Maintains full three-year accreditation status, monitors accreditation process/standards and HEDIS, and informs appropriate management and QI staff of any changes. Also coordinates the preparation of on-site audits conducted by external bodies.

• Conduct audits of work areas, such as member services and utilization management, to ensure compliance with activities or to assess service issues.

• Analyzes the audit results, makes appropriate recommendations for changes to improve compliance or level of service, works with the other departments to prepare a corrective action plan, prepares formal documentation of the audit, and monitors ongoing corrective action plan to ensure recommendations are being implemented.

• Coordinates Quality Improvement Activities (QIAS) including specific responsibilities for some of the QIAS as well as oversight and review of all QIAS to ensure compliance with accreditation standards.

• Conducts analysis of quality improvement activity findings, makes recommendations for corrective actions, prepares formal documentation of activities, presents findings to relevant committees, monitors corrective action plan to ensure recommended actions are being taken.

• Conducts miscellaneous accreditation activities, as assigned by management, including but not limited to: conducting clinical studies, including the review of medical records, to monitor the appropriateness of medical care; perform quality of service reviews, including tracking, trending, and profiling; investigate quality of service complaints taking necessary actions to improve clinical and service performance.

• Coordinates committee meetings and prepares committee minutes.

To Qualify for This Position, You'll Need the Following:

• Required Education: Bachelor's in a job related field

• Required Work Experience: 7 years health insurance industry, audit/compliance/investigations or corporate level related experience. 1 year project management experience. (may be concurrent)

• Degree Equivalency: 4 year job related work experience or Associate's and 2 years job related work experience. (Equivalency not applicable for the Celerian Group. Bachelor's degree required.)

• Required Skills and Abilities:

  • Conducts ongoing compliance audits

  • Investigates compliance issues

  • Prepares Audit Recommendations

  • Receives inquiries from third parties

  • Responds to requests for information.

• Required Software and Tools: Microsoft Office skills

We Prefer That You Have the Following:

• Strong Excel

• Strong knowledge of URAC

• Strong knowledge of NCQA

Our comprehensive benefits package includes the following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans, dental and vision coverage

• 401k retirement savings plan with company match

• Life Insurance

• Paid Time Off (PTO)

• On-site cafeterias and fitness centers in major locations

• Education Assistance

• Service Recognition

• National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information.

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.