Government Programs Compliance Specialist, Experienced

Blue Shield of CA; Oakland (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

Blue Shield of CA is seeking an Experienced Medi-Cal Specialist within the Government Programs Compliance team to support planning and identification of Medi-Cal requirements amid evolving federal and state rules. The role contributes to audit calendars, corrective actions, and policy maintenance.

Ideal candidates will have a bachelor’s degree or equivalent experience, at least 3 years in a related field, and knowledge of Medi-Cal compliance standards; CHC certification is preferred.

Qualifications

• Knowledge of Medi-Cal regulatory compliance standards and processes.
• Requires a bachelor's degree or equivalent experience.
• At least 3 years of prior relevant experience.
• CHC certification and additional degrees preferred.

Responsibilities

• Assist in planning and identification of Medi-Cal requirements within the department.
• Support Medi-Cal Compliance department activities such as audit calendars, corrective action plans, and mailboxes.
• Assist in maintaining intranet site, policies and procedures, and department communications.
• Contribute to audit calendars (CMS, DMHC, DHCS) and department deliverables as needed.

Skills

Regulatory compliance knowledge

Education

Bachelor's degree or equivalent experience

CHC Certification preferred

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 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