Your Role

The UM Delegation Oversight team provides oversight of the delegated groups to ensure compliance with Health Plan and Regulatory Requirements. The Program Coordinator, Experienced will report to the Delegation Oversight, Support Services Supervisor. In this role you will be responsible for organizing, tracking and data entry of delegated entities report(s) monitoring and auditing of submitted data including maintaining audit results and monthly reporting that track and assist the auditors in the comparison of compliance patterns of delegated parties.

Your Work

In this role, you will:

• Develop and provide complex analytical support to multiple projects simultaneously through the analysis and interpretation of data in support of cross-functional business operations for management review.
• Define business requirements and provides analysis to increase operational efficiency.
• Analyze actual results against plan and forecast and recommends interventions where appropriate, while identifying opportunities for improvement in operational performance and works cross-functionally to develop business solutions.
• Manage the design, development and/or implementation of new or enhanced systems projects or programs.
• Works closely with the delegation oversight team and communicates audit schedules, audit and corrective action plan results, organizational and regulatory requests to the delegated entities. This includes managing data in the DORMs system.
• Provides support to the auditors by providing training and clarification of general processes to our delegated entities upon request.
• Supports external department requests for data as it relates to delegation oversight - including but not limited to regulatory and internal control audits, various committee reports and information to support the Legal Department's responses to state agencies
• Obtains, organizes, and tracks delegated entities' data report submissions for compliance purposes but not limited to tracking, trending, and communicating to assure data can be compared for trends and noncompliance. Presents summary of all tracking reports to management, auditors, and other internal departments upon request, on a monthly basis and identifies areas of delinquency.
• Responsible for communicating with delegated entities with respect to notification of audit, including requesting of universes, communicating audit results and any follow-up Corrective Action Plan letter notifications.
• Works with delegation oversight leadership to maintain audit files (both paper and electronic) including development of online folders for oversight audits and corresponding data, requesting offsite storage, shredding when deemed appropriate and assisting in preparation of audit files/cases for regulatory audits.
• Other duties as assigned.

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 3 years of prior relevant experience
• Basic knowledge of internal DMHC, DHCS, CMS, and Medi-Cal, Medicare Reporting guidelines and processes for Delegation Oversight.
• Ability to effectively communicate with internal and external associates
• Ability to implement and coordinate effective procedures
• Ability to work in a fast-paced environment with minimal supervision
• Ability to handle multiple projects and is able to prioritize workflow
• Intermediate PC program user. (MS Word, Microsoft Office, PowerPoint, Excel, and Access)

Pay Range:

The pay range for this role is: $ 71280.00 to $ 99770.00 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.