Compliance Audit Services Specialist, Consultant
Company: Blue Shield of California
Location: Monterey Park
Posted on: March 22, 2020
At Blue Shield of California we are parents, leader, students,
visionaries, heroes, and providers. Everyday we come together
striving to fulfill our mission, to ensure all Californians have
access to high-quality health care at a sustainably affordable
price. For more than 80 years, Blue Shield of California has been
dedicated to transforming health care by making it more accessible,
cost-effective, and customer-centric. We are a not-for-profit,
independent member of the Blue Cross Blue Shield Association with
6,800 employees, more than $20 billion in annual revenue and 4.3
million members. The company has contributed more than $500 million
to Blue Shield of California Foundation since 2002 to have a
positive impact on California communities. Blue Shield of
California is headquartered in Oakland, California with 18
additional locations including Sacramento, Los Angeles, and San
Diego. We're excited to share Blue Shield of California has
received awards and recognition for - LGBT diversity, quality
improvement, most influential women in corporate America, Bay
Area's top companies in volunteering & giving, and one of the
world's most ethical companies. Here at Blue Shield of California,
we're striving to make a positive change across our industry and
the communities we live in - Join us!
Compliance Audit Services Specialist, Consultant:
This position will perform the following types of reviews and
audits that would address the requirements and recent agreements
between DMHC and the Plans. This would include system integrity
audits, compliance program review as well as oversight of internal
controls - such as ownership, organizational structure, and other
complex issues related to DMHC, DHCS, CMS and LA Care requirements.
These positions will work closely with Medical Informatics on
reviews of systems and operations based upon repeated financial
solvency CAPs as reported by the DMHC or as determined by Promise's
review of the annual/quarterly financial statements.
- Responsible for performing regulatory/contractual delegation
oversight control audits to ensure compliance with Federal and
State regulatory agencies. Assures compliance to external
specifications and standards. Conducts comprehensive regulatory
reviews using a standard audit model.
- Provides highly complex analysis and defines efficiency in
relation to compliance programs and internal controls.
- Coordinates the audit of compliance programs and internal
controls with other internal and external audit teams.
- Provide administrative oversight of 3rd party relationships
with performance/tracking systems.
- Participate in special projects as needed.
- Other duties as assigned.
Innovation & Complexity:
- Responsible for proactively improving upon existing processes
and systems using significant conceptualizing, reasoning and
- Works to influence others to accept audit results and
accountability for audit results.
- Results may serve as precedent for future decisions.
- Problems and issues faced are numerous, and typically undefined
where information is difficult to obtain.
- Conducts extensive investigation, critical thinking to
understand root cause of problems. Problems span a wide range of
difficult and unique issues across functions and/or
- Develops new perspectives and innovative approaches on existing
or new problems.
- Applies agile methods.
Communication & Influence:
- Communicates with parties within and outside of own job
- Has responsibilities for communicating with parties' external
to the organization, which may include customers or vendors.
- Works to influence others to accept job function's
view/practices, and agree to or accept new concepts, practices, and
- Requires ability to communicate with executive leadership
regarding matters of significant importance to the
- Generally, conducts briefings with senior leaders within the
Leadership & Talent Management:
- Provide guidance and training externally to provider
- Responsible for managing large, complex project initiatives of
strategic importance to the organization, involving large
- May direct the work of other individual contributors and/or act
as a cross-functional team lead.
Knowledge & Experience
- May require a bachelor's degree or equivalent and minimal to
moderate experience in managed care setting, healthcare industry or
- Extensive experience in health care specific to
compliance-operations, privacy, audit and legal investigative
- Requires deep job knowledge and application typically obtained
through advanced education combined with experience.
- Minimum of 10 years of prior relevant experience within a
managed healthcare organization with an emphasis on
- Certification from HCCA or equivalent experience or
Keywords: Blue Shield of California, Monterey Park , Compliance Audit Services Specialist, Consultant, Accounting, Auditing , Monterey Park, California
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