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 presentation, interviewing, and organizational skills with a strong attention to detail.

  • Ability to make sound decisions.

  • Strong knowledge of and proficiency in applying accounting principles and auditing standards.

  • Strong knowledge of and proficiency in healthcare operational and financial systems.

  • Ability to grasp and understand complex systems.

  • Ability to analyze details and determine impact to corporation.

  • Ability to understand management principles.

  • Good planning, leadership, and human relations skills.

We Prefer That You Have the Following:

• Medicare cost report auditing experience to include leading audits

• Strong Microsoft Excel skills

• HFS – Health Financial Systems, HIGLAS – CMS Ledger system, STAR – System for Tracking Audit and Reimbursement experience

• Certified Internal Auditor (CIA), Certified Public Accountant (CPA), or Certified Information Systems Auditor (CISA)

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.

Pay Range Information:

Range Minimum
$ 83,057.00

Range Midpoint
$ 123,554.00

Range Maximum
$ 164,051.00

Pay Transparency Statement:

Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.

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 .

Equal Employment Opportunity Statement

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.