Job Description

Your Role

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.

Your Work

In this role, you will:

• 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

Your Knowledge and Experience

• 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
• Professional certifications (CHC –Certification in Healthcare Compliance) & additional degrees preferred