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Blue Shield of California · 1 day ago

Government Programs Compliance Analyst, Consultant

California, United States

Full-time

Hybrid

Senior Level

7+ years exp

Blue Shield of California is a nonprofit organization focused on creating a sustainable healthcare system. The Government Programs Compliance Analyst, Consultant will support the compliance program by managing regulatory impacts across various business areas and ensuring compliance with Medi-Cal requirements.

Financial ServicesHealth InsuranceNon Profit

Responsibilities

Provides 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

Work collaboratively and advises diverse business areas across the enterprise on the development of legally compliant solutions for newly enacted or revised Medi-Cal requirements

Support the implementation of quality, repeatable, and documented CMS, DMHC and DHCS regulatory compliance processes

Conduct decision-making guided by resource availability and functional objectives

Conduct audits of complex issues independently

Conducts calibration of risk and controls with business units supporting the Medi-Cal line of business

Escalates and proposes resolution for low to moderately complex CMS, DMHC and DHCS regulatory and process issues

Develops, prepares, and presents low to complex analyses, reports, and recommendations on Medi-Cal requirements to department management

Supports day-to-day operations of the Medi-Cal Compliance department

Supports other Medi-Cal Compliance department initiatives and projects

Qualification

Compliance experienceKnox-Keene Act knowledgeRegulatory compliance standardsAnalytical skillsRisk assessmentExcel proficiencyPowerPoint proficiencySharePoint proficiencyProfessional certifications

Required

Requires a college degree or equivalent experience

Requires a minimum of 7 years of prior relevant experience

Requires extensive experience in the compliance department for a managed care health plan

Extensive and expert knowledge of Knox-Keene Act, California Code of Regulations Titles 22 and 28, and Code of Federal Regulations Title 42 regulatory compliance standards and processes

Strong analytical and investigative skills including risk assessment, mitigation and corrective actions plans

Experience working directly with the California Department of Health Care Services and the California Department of Managed Health Care

Competent in Excel, PowerPoint, and SharePoint