Summary
 

Why should you join the BlueCross BlueShield of South Carolina family of companies?

Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose:

Responsible for organizing the audit block into productive units or teams and directing the activities of the teams to meet the expectations of the department, the corporation, and the Centers for Medicare and Medicaid Service (CMS). Ensures workload production goals and standards are met and appropriate policies/work instructions are developed and communicated to staff.

Description
 

Logistics: Palmetto GBA– one of BlueCross BlueShield's South Carolina subsidiary companies.

Location: This position is full-time (40-hours/week) Monday-Friday working REMOTE in the U.S., or onsite at our Columbia, SC location. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime.

What You’ll Do:

• Manages audit work to ensure appropriate flow of production is achieved within required timeliness standards. Reports results on a regular basis to management.

• Responds to provider questions on a wide range of audit topics and meets as necessary to resolve disputed items.

• Prepares instructions for staff to assist their understanding of Medicare regulations and company policies.

• Assists in the development of QMS instructions and programs and in the continued ISO certification of the unit.

• Communicates with and responds to inquiries from CMS and other government/external law enforcement agencies.

• Evaluates the composition of existing staff, interviews and hires new staff, completes annual performance evaluations, oversees promotional decisions, and shifts staff as needed to meet work requirements.

• Ensures audits are of sufficient quality and in compliance with all department, company, and CMS requirements through periodic review and inspection of work products. Responds to audit inquiries and findings produced by external reviewers.

• Performs special projects as assigned by management and expands working knowledge/technical skills.

 

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

• Required Education: Bachelor’s in a job related field.

• Required Experience:

  • 5 years experience in operational/functional audits within the healthcare industry.

  • 2 years supervisory audit experience or equivalent military experience in grade E4 or above.

• Required Software and tools: Microsoft Office

• Required Skills and Abilities:

  • Strong interpersonal skills and the ability to work professionally with persons at all levels.

  • Ability to maintain effective working relationships.

  • Ability to communicate clearly and effectively in oral and written form.

  • Strong pr