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Resp & Qualifications

PURPOSE:

This position is accountable for the oversight of the No Surprises Act Independent Dispute Resolution ("NSA IDR") team. Key responsibilities include managing the team, gathering, analyzing and disseminating guidance, regulations and caselaw on the NSA and the NSA IDR process and ensuing that the team is educated on the new updates to process and legal arguments with respect to the NSA and the NSA IDR process. This position will collaborate with Public Policy and Government Affairs (PPGA), Legal, Business Health Services, Claims Operations and Enterprise Project Management Office (EPMO) to ensure that all NSA IDR requirements are reviewed and agreed upon by stakeholders and implemented. This position is also accountable for overseeing, providing analysis and recommendations on the NSA for strategic decision making both internally and externally, and for ensuring support of the company's business objectives and compliance.

ESSENTIAL FUNCTIONS:

+ Accountable for the tracking, analysis and evaluation of CareFirst NSA IDR data and statistics.

+ Maintains a comprehensive NSA IDR tracker and monitors regulatory guidelines.

+ Tracks the achievement of CareFirst NSA IDR process.

+ Works with Legal, Business and EPMO to ensure project implementation activities result in compliance with many new requirements associated with the NSA IDR process.

+ Provide interpretation of any NSA regulations and regulatory rules/guidelines to ensure compliance and collaborate with Mandates, Legal and Corporate Compliance.

+ Continuously analyzes and aligns all processes to Policies. and Procedures, SOPs, workflows, and systems and ensure they are in compliance and alignment with NSA regulations and remain updated and current.

+ Accountable for staffing activities including recruitment, interviewing, selection, and hiring qualified staff. Provides oversight and direction to the employees in accordance with the organization's policies and procedures.

+ Responsible for coaching, mentoring and developing staff, including overseeing new employee onboarding and providing career development planning and opportunities; including delegating as appropriate to direct reports.

+ Responsible for performance management and completion of annual performance evaluations. Provides timely performance feedback throughout the year via employee recognition, rewards and disciplinary action as appropriate. Maintains transparent communication and appropriately communicates organizational information through department meetings, one-on-one meetings, and appropriate email, IM, and regular interpersonal communication.

+ Accountable for reporting and documentation. Establishes and maintains auditable business processes for the efficient collection and submission of data required by BCBSA and regulatory bodies.

SUPERVISORY RESPONSIBILITY:

This position manages people.

QUALIFICATIONS:

**Education Level:** Bachelor's Degree in Healthcare Compliance, Risk Management, Business Administration or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

**Experience:** 5 years experience in health insurance industry, managed care and government programs, health insurance compliance programs, or related fields. 1 year supervisory experience or demonstrated progressive leadership experience.

**Preferred Qualifications** :

+ Understanding of federal, state, and local legislative and regulatory processes, public policy analysis.

+ Comprehensive understanding of the healthcare payor industry, insurance products, and regulation.

+ Expansive knowledge of CareFirst operations.

Knowledge, Skills and Abilities (KSAs)

+ Decision-making skills to influence management and internal/external partners.

+ Demonstrated leadership abilities and effectiveness in matrix management. Strong management and team building skills.

+ Excellent business analysis and process improvement skills. Ability to work well with all levels of management, including senior and executive levels.

+ In-depth knowledge of the NSA IDR process.

Salary Range: $113,760 - $211,167

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

IDR Expenses

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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REQNUMBER: 21312