Senior Government Programs Compliance Specialist

Blue Shield of California; California (MO); Hybrid; USD 70,000 - 80,000; Full time

Job summary

Blue Shield of California Promise Health Plan is seeking an experienced Government Programs Compliance Medi-Cal Specialist, Experienced to support planning and identification of Medi-Cal requirements in response to ongoing or new regulatory changes.

You will help develop and maintain the department's audit calendars, assist with CMS/DMHC/DHCS audits, data collection and analyses, and ensure documentation and processes align with Blue Shield and Promise strategy.

Qualifications

• Bachelor's degree or equivalent experience.
• Minimum 3 years of prior relevant experience.
• Knowledge of Medi-Cal regulatory compliance standards and processes.
• Professional certifications (CHC-Certification in Healthcare Compliance) and additional degrees preferred.

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 resolve 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.

Skills

Medi-Cal compliance knowledge

Regulatory compliance

Data analysis

Education

Bachelor's degree

CHC Certification in Healthcare Compliance

Tools

Medi-Cal tracking system

Job description

Blue Shield of California Promise Health Plan is seeking an experienced Government Programs Compliance Medi-Cal Specialist, Experienced to support planning and identification of Medi-Cal requirements in response to ongoing or new regulatory changes.

You will help develop and maintain the department's audit calendars, assist with CMS/DMHC/DHCS audits, data collection and analyses, and ensure documentation and processes align with Blue Shield and Promise strategy.