Compliance Audit Services Specialist, Principal
16 hours ago
The Compliance Audit Services Specialist, Principal ensures adherence to regulatory and contractual compliance for Blue Shield of California Promise Health Plan. This role involves monitoring operational areas, managing contracts, and developing processes to enhance compliance efficiency. The position requires strong analytical skills, cross-functional collaboration, and extensive experience in Medi-Cal mandate implementation.
Your Role
The Promise Compliance Audit Services team oversees all functions of an effective Compliance Program for Blue Shield of California Promise Health Plan. The Compliance Audit Services, Principal will report to the Senior Director, Compliance Audit Services. In this role you will be involved in monitoring and oversight of operational business areas to ensure compliance with contractual and regulatory requirements. You will be responsible for interfacing with other departments regarding implementation of new or updated regulatory mandates. You will also act as a subject matter expert for regulatory inquiries and support the Compliance Program as needed.
Your Work
In this role, you will:
- Be responsible for preparation and submission all standard and nonstandard insurance documents and researching related issues of highly complex nature and recommending solutions
- Contract management to evaluate adequacy of standard, on-standard, and exception insurance contract requirements & provide recommendations
- Oversee and develop new processes and procedure to ensure consistency, accuracy, and efficiency of coordination activities with respect to risk
- Coordinate routine and nonroutine processes for insurance application activities between the Company, brokers, and liability insurance carriers to ensure Certificates of Insurance are up-to date
- Provide highly complex analysis and define potential loss areas and appropriate type and level of loss protection to be insured
- Directs the work of stakeholders or acts as a cross-functional team lead
- Works collaboratively in a cross-functional, execution focused environment on large and complex projects of strategic importance to the organization
- Independently prepares clear and concise documentation and leadership reporting
- Leverages industry best-practice & benchmarking data to drive program maturation
- Oversees the maintenance of existing GRC process documentation, policies, internal controls, training resources, & communications and leads team through the development of new artifacts to support program objectives
Your Knowledge and Experience
- Requires a bachelor's degree or equivalent experience
- Requires at least 10 years of prior relevant experience
- Must have at least 2 years of prior Medi-Cal mandate implementation experience
- Certification in Health Care Compliance preferred
- Requires strong written and verbal communication skills, relationship building and facilitation skills
- Requires strong negotiation skills and ability to successfully interact with all levels of management
- Preferred experience planning and leading major initiatives/projects
- Proficient in Microsoft office (Excel, Outlook, Word, Visio, etc.)
Pay Range: The pay range for this role is $136,400.00 to $204,600.00 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.
Keywords:
compliance audit, healthcare compliance, contract management, regulatory compliance, Medi-Cal mandates, risk management, insurance documentation, policy oversight, stakeholder management, program development
-
Oakland, CA, United States Blue Shield of California Full timeYour Role The Promise Compliance Audit Services team oversees all functions of an effective Compliance Program for Blue Shield of California Promise Health Plan. The Compliance Audit Services, Principal will report to the Senior Director, Compliance Audit Services. In this role you will be involved in monitoring and oversight of operational business areas...
-
Oakland, CA, United States Blue Shield of California Full timeYour Role The Promise Compliance Audit Services team oversees all functions of an effective Compliance Program for Blue Shield of California Promise Health Plan. The Compliance Audit Services, Principal will report to the Senior Director, Compliance Audit Services. In this role you will be involved in monitoring and oversight of operational business areas to...
-
Compliance Audit Services Specialist, Principal
2 weeks ago
Oakland, United States Blue Shield of California Full timeYour Role The Promise Compliance Audit Services team oversees all functions of an effective Compliance Program for Blue Shield of California Promise Health Plan. The Compliance Audit Services, Principal will report to the Senior Director, Compliance Audit Services. In this role you will be involved in monitoring and oversight of operational business areas to...
-
Oakland, United States Blue Shield of California Full timeYour Role The Promise Compliance Audit Services team oversees all functions of an effective Compliance Program for Blue Shield of California Promise Health Plan. The Compliance Audit Services, Principal will report to the Senior Director, Compliance Audit Services. In this role you will be involved in monitoring and oversight of operational business areas to...
-
Oakland, United States Blue Shield of California Full timeYour Role The Promise Compliance Audit Services team oversees all functions of an effective Compliance Program for Blue Shield of California Promise Health Plan. The Compliance Audit Services, Principal will report to the Senior Director, Compliance Audit Services. In this role you will be involved in monitoring and oversight of operational business areas to...
-
Compliance Audit Services Specialist, Principal
2 weeks ago
Oakland, United States Blue Shield of California Full timeYour Role The Promise Compliance Audit Services team oversees all functions of an effective Compliance Program for Blue Shield of California Promise Health Plan. The Compliance Audit Services, Principal will report to the Senior Director, Compliance Audit Services. In this role you will be involved in monitoring and oversight of operational business areas to...
-
Oakland, United States Blue Shield of California Full timeYour RoleThe Promise Compliance Audit Services team oversees all functions of an effective Compliance Program for Blue Shield of California Promise Health Plan. The Compliance Audit Services, Principal will report to the Senior Director, Compliance Audit Services. In this role you will be involved in monitoring and oversight of operational business areas to...
-
Oakland, United States Blue Shield of California Full timeYour Role The Promise Compliance Audit Services team oversees all functions of an effective Compliance Program for Blue Shield of California Promise Health Plan. The Compliance Audit Services, Principal will report to the Senior Director, Compliance Audit Services. In this role you will be involved in monitoring and oversight of operational business areas to...
-
Oakland, United States Blue Shield of California Full timeYour Role The Promise Compliance Audit Services team oversees all functions of an effective Compliance Program for Blue Shield of California Promise Health Plan. The Compliance Audit Services, Principal will report to the Senior Director, Compliance Audit Services. In this role you will be involved in monitoring and oversight of operational business areas to...
-
Oakland, CA, United States Blue Shield of California Full timeYour Role The Promise Compliance Audit Services team oversees all functions of an effective Compliance Program for Blue Shield of California Promise Health Plan. The Compliance Audit Services, Principal will report to the Senior Director, Compliance Audit Services. In this role you will be involved in monitoring and oversight of operational business areas to...
-
Compliance and Coding Specialist
3 days ago
Oakland, California, United States Alameda Health System Full timeSUMMARY:As a Compliance and Coding Specialist at Alameda Health System, you will be responsible for ensuring the accuracy and quality of medical records and coding compliance. This role requires a strong understanding of healthcare regulations and coding principles.Key Responsibilities:1. Analyze and assess risks related to billing and coding rules and...
-
Healthcare Compliance Specialist
7 days ago
Oakland, California, United States Alameda Health System Full timeWe are seeking a skilled Healthcare Compliance Specialist to join our team at Alameda Health System. In this role, you will play a critical part in ensuring the accuracy and quality of clinical documentation, while also educating healthcare providers on compliance-related topics.As a key member of our Revenue Cycle department, you will work closely with...
-
Privacy Program Specialist, Consultant
1 week ago
Oakland, United States Blue Shield of California Full timeYour Role The Privacy Office develops and oversees Blue Shield’s Privacy Program. The Privacy Program ensures that Blue Shield and its affiliated covered entities, including Blue Shield of California Promise Health Plan, are in compliance with state and federal privacy laws and regulations, including the Health Insurance Portability and Accountability Act...
-
Privacy Program Specialist, Consultant
17 hours ago
Oakland, United States Blue Shield of California Full timePrivacy Program Specialist, Consultant at Blue Shield of California summary: The Privacy Program Specialist, Consultant at Blue Shield plays a critical role in ensuring compliance with state and federal privacy laws, including HIPAA and HITECH. This position involves monitoring compliance, conducting privacy assessments, developing training and policies,...
-
Principal Business Finance Analyst
4 weeks ago
Oakland, United States PG&E Corporation Full timeRequisition ID # 157813 Job Category: Accounting / Finance Job Level: Manager/Principal Business Unit: Finance Work Type: Hybrid Job Location: Oakland Department Overview Finance’s vision is to build and sustain leading finance capabilities to support PG&E’s vision. The Enterprise Planning organization leads the company’s work and financial...
-
Network Engineer, Principal
4 weeks ago
Oakland, United States Blue Shield of California Full timeYour Role The Data Center and Infrastructure team is responsible for the design, engineering, administration, and support of corporate WAN, LAN and network infrastructure. The Network Engineer, Principal will report to the Director, Technical Operations. In this role you will provide network architecture and design, implement network infrastructure, and...
-
Electric Program Manager, Principal
4 weeks ago
Oakland, United States Pacific Gas & Electric CO Full timeThe Principal Electric Program Manager plays a crucial role in supporting PG&Es wildfire risk reduction efforts. This position also leads the development strategic plans to meet regulatory or internal wildfire risk reduction goals. This individual e Program Manager, Manager, Principal, Program Leader, Project Management, Leadership, Business Services
-
Privacy Program Specialist, Consultant
2 weeks ago
Oakland, United States Blue Shield of California Full timeYour Role The Privacy Office develops and oversees Blue Shield’s Privacy Program. The Privacy Program ensures that Blue Shield and its affiliated covered entities, including Blue Shield of California Promise Health Plan, are in compliance with state and federal privacy laws and regulations, including the Health Insurance Portability and Accountability Act...
-
Privacy Program Specialist, Consultant
1 week ago
Oakland, United States Blue Shield of California Full timeYour Role The Privacy Office develops and oversees Blue Shield’s Privacy Program. The Privacy Program ensures that Blue Shield and its affiliated covered entities, including Blue Shield of California Promise Health Plan, are in compliance with state and federal privacy laws and regulations, including the Health Insurance Portability and Accountability Act...
-
Vice President, Deputy Chief Compliance Officer
4 weeks ago
Oakland, United States Kaiser Permanente Full timeJob Summary: The Deputy Chief Compliance Officer is responsible for assisting the Chief Compliance and Privacy Officer in managing an effective ethics and compliance program. This includes infrastructure development, policy management, training, monitoring/auditing, conducting and documenting investigations, addressing and resolving violations, errors, and...
