Government Programs Compliance Analyst, Consultant

Your Role

The Promise Medi-Cal Compliance team oversees and coordinates Blue Shield Promise Health Plan’s (BSCPHP) compliance program. The Government Programs Compliance Analyst, Consultant will report to the Senior Director, Government Programs Compliance. In this role you will provide 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.

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
• 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 

Your Knowledge and Experience

• 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
• Professional certifications and additional degrees a plus