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.

Responsibilities

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

Qualifications

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

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.