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, Consultant will report to the Senior Manager, Government Programs Compliance Medi-Cal Manager. In this role you will be providing 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. You will collaboratively and advises diverse business areas across the enterprise on the development of legally compliant solutions for newly enacted or revised Medicare or Medi-Cal requirements.

Your Work

In this role, you will:

• 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
• Works collaboratively and advises diverse business areas across the enterprise on the development of legally compliant solutions for newly enacted or revised Medi-Cal requirements
• Supports the implementation of quality, repeatable, and documented CMS, DMHC and DHCS regulatory compliance processes
• Conducts decision-making guided by resource availability and functional objectives.
• Conducts 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
• Supports day-to-day operations of the Medi-Cal Compliance department
• Supports other Medi-Cal Compliance department initiatives and projects
• Other duties as assigned

our Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• Has expert knowledge of Medicare or Medi-Cal regulatory compliance standards and processes
• Professional certifications a plus
• Additional degrees a plus

Pay Range: The pay range for this role is $109,120.00 to $163,680.00 for California.

Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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