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Compliance Audit Services Specialist, Senior

ComplianceAudit Services Specialist, Senior - 18002K7 Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution. We're hiring smart thinkers and doers whowant to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.  Description   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. Responsible for revision of policies and procedures to comply with regulatory changes and for training internal staff or delegated providers. Model includes monitoring and review of self-reported compliance, developing an audit plan, executing the audit, identifying corrective action opportunities, creating a final report, and following up on outstanding issues. Responsible for monitoring and reporting operational timeliness of providers that assures compliance to in-house and/or external specifications and standards. Responsible for instituting corrective action for non-compliance. Negotiates corrective action plans. Participates in the development of training. Develops correspondence to external entities. Coordinates auditing process with external providers and internal business units. Manages internal & external data reporting on compliance, interdepartmental performance reviews, and monthly claims delegation compliance reviews. Participates in projects and taskforces as assigned. Other duties as assigned. Responsible for making moderate to significant improvements of processes, systems or products to enhance performance of job area   Innovation & Complexity o             Issues faced are numerous and undefined, and require detailed information gathering, analysis and investigation to understand the problem. Problems are difficult and moderately complex, typically impact multiple departments or specialties, and are usually solved through drawing from prior experience and analysis of issues. Develops new perspectives and innovative approaches on existing problems.        Communication & Influence Communicates with parties within and outside of own job function.   Has responsibility for communicating with parties' external to the organization (e.g., customers, vendors, etc.).   Works to influence parties within and outside of the job function at an operational level regarding policies, procedures and practices.   Leadership & Talent Management o             Generally, responsible for providing guidance, coaching and training to other employees within job area.   o             Generally, responsible for managing major/complex projects involving delegation of work and review of work products.       Qualifications   Thorough experience in health care compliance, legislative or legal Services.   o             Extensive experience in health care, legal services, privacy, audit or investigative services.   o             Excellent analytical and problem-solving skills.   o             Requires deep knowledge of job area typically obtained through advanced education combined with experience.   o             Typically, viewed as a specialist within discipline. May have broad knowledge of project management.   o             Typically, requires a college degree or equivalent experience and minimum 5 years of prior relevant experience.  18002K7
Salary Range: NA
Minimum Qualification
5 - 7 years

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