In this role as Provider Compliance and Policy Manager, you will manage and coordinate audits on behalf of the Provider Credentialing department. Review and provide complete and accurate documentation and results to auditors and government/regulatory agencies as requested, consult on potential issues, and formulate Wellmark's response. Support timely completion of any recommended actions. Interpret state and federal regulations as well as Blue Cross Blue Shield Association (BCBSA) changes and provide impact to stakeholders regarding changes which may impact Provider Credentialing. Support the management, coordination, and completion of Credentialing regulatory changes and projects. Collaborate and work closely with Legal, Compliance, and Government Relations in the interpretation of regulations in support of business-specific planning and execution. Complete the annual update of department policies and procedures and own the creation of policies/procedures in PolicyTech.
Required: Bachelor's degree in accounting or related field or direct and applicable work experience. 4+ years of work experience in insurance operations, provider network administration, contracting, credentialing, medical policy, or similar area preferred. 2+ years of work experience completing audits or coordinating audits Project management or business process experience. Demonstrates the ability to review, analyze, and interpret regulations/guidelines and provide insights or recommendations. Excellent analytical, research, and critical thinking skills. Strong attention to detail. Ability to monitor, collect, or record data and assess its accuracy, validity, or integrity. Excellent verbal and written communication skills. Ability to consult with stakeholders, apply subject matter expertise and influence decisions appropriately. Ability to build relationships throughout the organization Proficient with Microsoft Office (e.g., Word, Excel, Outlook) and web-based applications (e.g., PolicyTech), with the ability to learn new technology quickly. Ability to measure and evaluate work processes and utilize appropriate resources to identify opportunities or implement solutions. Flexible and adaptable to change. Ability to lead others through change.
Provider Compliance & Policy Manager • Des Moines, IA, United States
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