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Mandates Control Specialist, Consultant

Company: Blue Shield of CA
Location: Monterey Park
Posted on: March 27, 2020

Job Description:

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. Were excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Areas top companies in volunteering & giving, and one of the worlds most ethical companies. Here at Blue Shield of California, were striving to make a positive change across our industry and the communities we live in Join us!

The Mandates Control Specialist, Consultant reports to the Sr. Manager, Mandates Compliance. Under the direction of Blue Shields SVP General Counsel and Corporate Secretary, the Mandates Control Group (MCG) was established and is accountable for ensuring mandates are implemented and compliance is maintained throughout the enterprise. Mandates include Federal, State, Blue Cross Blue Shield Association, Covered California and Medicare requirements.

The Mandates Control Specialist will monitor the progression of mandate implementation, validate and verify compliance, and provide visibility and transparency of enterprise wide mandates compliance.

The Mandates Control Specialist, Consultant reports to the Sr. Manager, Mandates Compliance. Under the direction of Blue Shields SVP General Counsel and Corporate Secretary, the Mandates Control Group (MCG) was established and is accountable for ensuring mandates are implemented and compliance is maintained throughout the enterprise. Mandates include Federal, State, Blue Cross Blue Shield Association, Covered California and Medicare requirements.

The Mandates Control Specialist will monitor the progression of mandate implementation, validate and verify compliance, and provide visibility and transparency of enterprise wide mandates compliance.

ESSENTIAL RESPONSIBILITIES:

Drives and manages identification and scoping of impacts across cross-functional business areas due to newly enacted or revised state, federal legislation, Blue Cross Blue Shield Association rules, and Covered California contractual requirements (mandates).

Works collaboratively and advises diverse business areas across the enterprise on the development of legally compliant solutions for newly enacted or revised mandates.

Documents final compliance solutions identified risks and mitigation plans in a controlled document.

Monitors implementation to ensure on track, risks are identified, mitigation plans are developed, escalates as appropriate.

Supports the implementation of quality, repeatable and documented mandate compliance processes.

Conducts mandate compliance verification, where compliance gaps are identified, validates quality, timeliness and progress of corrective action plans.

Escalates and proposes resolution for low to moderately complex mandate and process issues.

Develops, prepares and presents low to medium complexity analyses, reports and recommendations to MCG Management.

Supports day to day operations of the Mandates Control Group.

Support other MCG initiatives and projects and performs other duties as assigned.

Other duties as assigned.

KNOWLEDGE AND EXPERIENCE:

Thorough experience in health care compliance, legislative or legal Services.

Extensive experience in compliance, health care, legal services, privacy or investigative services.

Excellent analytical and problem-solving skills.

Requires deep knowledge of job area typically obtained through advanced education combined with experience.

Typically, viewed as a specialist within discipline. May have broad knowledge of project management.

Typically, requires a college degree or equivalent experience and minimum 7 years of prior relevant experience.



ESSENTIAL RESPONSIBILITIES:

Drives and manages identification and scoping of impacts across cross-functional business areas due to newly enacted or revised state, federal legislation, Blue Cross Blue Shield Association rules, and Covered California contractual requirements (mandates).

Works collaboratively and advises diverse business areas across the enterprise on the development of legally compliant solutions for newly enacted or revised mandates.

Documents final compliance solutions identified risks and mitigation plans in a controlled document.

Monitors implementation to ensure on track, risks are identified, mitigation plans are developed, escalates as appropriate.

Supports the implementation of quality, repeatable and documented mandate compliance processes.

Conducts mandate compliance verification, where compliance gaps are identified, validates quality, timeliness and progress of corrective action plans.

Escalates and proposes resolution for low to moderately complex mandate and process issues.

Develops, prepares and presents low to medium complexity analyses, reports and recommendations to MCG Management.

Supports day to day operations of the Mandates Control Group.

Support other MCG initiatives and projects and performs other duties as assigned.

Other duties as assigned.

KNOWLEDGE AND EXPERIENCE:

Thorough experience in health care compliance, legislative or legal Services.

Extensive experience in compliance, health care, legal services, privacy or investigative services.

Excellent analytical and problem-solving skills.

Requires deep knowledge of job area typically obtained through advanced education combined with experience.

Typically, viewed as a specialist within discipline. May have broad knowledge of project management.

Typically, requires a college degree or equivalent experience and minimum 7 years of prior relevant experience.



External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Keywords: Blue Shield of CA, Monterey Park , Mandates Control Specialist, Consultant, Professions , Monterey Park, California

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