At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
Job Summary
This position is responsible for auditing operations compliance with accreditation and regulatory requirements in assigned areas. Ensuring compliance with Plan, BCBSA, NCQA and State and Federal requirements. Researching and reporting monthly on trends. This will include monthly documented summaries, receipts, and how these impact accreditation requirements. Recommending and implementing technical solutions (i.e. Enterprise Appeals Application requirements) and communicating to the management team of the need/gap. Gathering data, analyzing data, and preparing reports including disseminating information from various sources and systems. Supporting projects and initiatives and resolving issues by working with staff within the department or across departments.
Work Environment:
This is a hybrid role: 3 days onsite and 2 days from home. You must live in Illinois, New Mexico, or Texas.
Required Job Qualifications:
Bachelor degree and 2 years of insurance experience OR 6 years' insurance experience.
Knowledge of health care regulatory and legislative process; experience reading and interpreting legislation.
Knowledge or experience reviewing accreditation standards and evaluating level of compliance, identifying challenges and proposing solutions.
Knowledge or experience monitoring compliance and managing evidence documents.
Experience preparing monthly reports and forecasting.
Research skills.
Analytical skills.
Detail orientation and organizational skills; experience meeting deadlines on time.
Ability and willingness to travel, including overnight stays.
Clear and concise verbal and written communication skills.
PC proficiency to include MS Office products.
Preferred Job Qualifications:
Audit experience.
Knowledge of Accreditation (i.e. NCQA, URAC, etc.)
PC proficiency to include Word, Excel, and PowerPoint.
Knowledge of Premier Provider Web (PPW).
Knowledge of quality review of Provider Data Entry Staff.
Knowledge or experience in provider networking, credentialing, and contracting.
Knowledge or experience in enterprise PDM business rules.
Knowledge or experience in NOSD internal systems (E-Status, PPW, CAQH, SF).
Ability to handle multiple projects in an environment of urgent and shifting deadlines.
Data auditing experience.
Relocation assistance will not be provided for this position.
Sponsorship will not be provided for this position.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Base Pay Range
$39,900.00 - $88,800.00
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