Government Programs Compliance Medi-Cal Specialist, Experienced

Blue Shield of California • Oakland, CA

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About The Position

The Blue Shield of California Promise Health Plan Compliance team is responsible for the administration and oversight of an effective compliance program. The Government Programs Compliance Medi-Cal Specialist, Experienced will report to the Government Programs Compliance Medi-Cal Manager, Senior Manager. In this role you will be providing support for the planning and identification of Medi-Cal requirements within the department due to ongoing, newly enacted, or revised federal or state regulatory requirements. This role also supports Medi-Cal Compliance department activities e.g. development & maintenance of the department audit calendar, CMS, DMHC and DHCS audit calendar, corrective action plans, department mailboxes, intranet website, policies and procedures, and other items as needed.

Requirements

• Requires a bachelor's degree or equivalent experience
• Requires at least 3 years of prior relevant experience
• Requires knowledge of Medi-Cal regulatory compliance standards and processes

Nice To Haves

• Professional certifications (CHC –Certification in Healthcare Compliance)
• Additional degrees

Responsibilities

• Provide support for the planning and identification of Medi-Cal requirements within the department due to ongoing, newly enacted or revised regulatory requirements
• Support the implementation of quality, repeatable and documented compliance processes and escalate and propose resolution for low complexity requirements and process issues
• Support maintenance and enhancements to the Medi-Cal Compliance tracking system(s) and/or application(s)
• Support Medi-Cal Compliance department activities including development & maintenance of the department audit calendar, external regulatory audit calendar, department mailboxes, intranet website, policies and procedures, and other items as needed
• Be responsible for data collection, retention, and the development of low complexity analyses and reports
• Assists with routine departmental functions and initiatives, as needed
• Participates in multiple projects or initiatives within job area and other duties as assigned
• Supports ongoing alignment with Blue Shield and Promise strategy and company objectives

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level