Government Programs Compliance Specialist, Senior

Blue Shield of California•Oakland, CA

1d•Hybrid

About The Position

The Promise Medi-Cal Compliance team oversees and coordinates Blue Shield Promise Health Plan’s (BSCPHP) compliance program. The Government Programs Compliance Specialist, Senior will report to the Director, Government Programs Compliance. In this role you will be providing assistance with driving and managing the identification and scoping of impacts across cross-functional business areas due to ongoing, newly enacted, or federal and state regulatory requirements. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Requirements

Requires a bachelor's degree or equivalent experience
Requires at least 5 years of prior relevant experience
Knowledge and understanding of Knox-Keene Act, California Code of Regulations Titles 22 and 28, and Code of Federal Regulations Title 42 regulatory compliance standards and processes
Requires health plan experience, Medi-Cal experience preferred
Strong analytical, regulatory reporting, data reporting including risk assessment and mitigation
Competent in Excel, SharePoint, PowerPoint

Nice To Haves

Professional certifications and additional degrees a plus

Responsibilities

Document final compliance solutions, identified risks, and mitigation plans in a controlled document
Monitor implementation of corrective action plans to ensure on track, risks are identified, mitigation plans are developed; escalates as appropriate
Summarize and distribute low to complex federal and state updates to impacted areas
Conduct federal and state regulatory compliance verification; where compliance gaps are identified, validates quality, timeliness, and progress of corrective action plans
Conducts more complex audits of Medi-Cal functions
Manage and maintain Medi-Cal Compliance department activities e.g. department mailboxes, intranet website, policies and procedures, and other items as needed
Supports calibration of risk and controls with business units supporting the Medi-Cal line of business
Develops, prepares, and presents analyses, reports, and recommendations to department management and other stakeholders of federal and state requirements
Provides day-to-day support guidance to areas that support Medi-Cal products on low to moderately complex inquiries
Participates in multiple projects or initiatives within and outside of the department and other duties as assigned