Operations Specialist, Experienced

3 weeks ago


Sacramento, United States Blue Shield of CA Full time

Your Role

The Provider Dispute Resolution (PDR) regulatory team completes a variety of audits and researches and responds to regulatory complaints associated with the different regulatory agencies that govern PDR operations, which include, but are not limited to the DMHC, DHCS, CMS, and LA Care. The Operations Specialist, Experienced will report to the Director of PDR. In this role you will work on Medi-Cal regulatory audits and concerns associated with the DMHC, DHCS and LA Care regulatory agencies. You will also be the liaison for the BSC Medi-Cal compliance team and regulatory agencies. As an Operations Specialist, you will work on updating and creating DLPs for the Medi-Cal line of business, provide second level support to QA audit staff and supervisors, and assist in preparing for and participating in regulatory audits. This position will also be considered a Medi-Cal PDR SME for various inter-departmental projects.

Your Knowledge and Experience

  • Requires a bachelor's degree or equivalent experience
  • Requires at least 3 years of prior relevant experience
  • Requires prior auditing and/or compliance/regulatory experience
  • Requires previous experience working for a payor in claims or similar business unit
  • Requires knowledge and proficiency of Microsoft Systems such as Power Point, Excel, and Word
  • Requires expertise in the Medi-Cal line of business
  • Preferred expertise in the Commercial and/or Medicare line of business

Pay Range

The pay range for this role is: $66700.00 to $93390.00 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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