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Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Financial Compliance Auditor III Finance is a hybrid role and is responsible for various tasks within the Financial Compliance Unit which include, but not limited to, performing, reporting, and corrective action plan monitoring of financial solvency reviews of plan partners, participating provider groups, capitated hospitals, specialty health plans, and vendors contracted with L.A. Care. This position is responsible for the overall financial solvency compliance on-going monitoring of assigned delegates across all lines of business including Medi-Cal, Covered California, D-SNP, and PASC-SEIU. This role works closely with the Manager and other team members on the identification and resolution of issues in a timely and efficient manner. This position leads assigned audits independently in accordance with general accepted auditing standards, generally accepted accounting principles (GAAP), regulations of the Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and other federal and state guidelines. Responsible for the on-going communication, collaboration, and issue resolution on financial solvency issues with interdepartmental personnel, key stakeholders, and delegates. Serves as a subject matter expert,and mentor for other staff. #LI-Hybrid Duties <ul><li>This position is responsible for all aspects of financial solvency reviews including, but not limited to, the planning, execution, continuous monitoring, and reporting of annual financial audits, quarterly and annual financial analyses (ratio and trending analyses), and special projects.</li><li>Provides timely and accurate deliverables to ensure financial solvency compliance with regulatory and contractual requirements for plan partners, participating provider groups, capitated hospitals, specialty health plans, and vendors.</li><li>Supports the design, implementation, and reporting of special projects such as Medical Loss Ratio.</li><li>Supports the design and implementation of reports and tools for corrective action plan issuance and non-compliance notifications.</li><li>Supports the assessment, communication, implementation of regulatory requirements that may impact internal processes.</li><li>Supports the formalization of key internal processes and monitoring tools with desktop procedures and applicable policies and procedures development.</li><li>Responsible for the financial audit team's pre-delegation reviews and delivers monthly/quarterly request updates to various business units.</li><li>Responsible for the completion and monitoring of monthly membership report.</li><li>Accountable for the completion of requests from Legal Department, Delegation Oversight's monitoring oversight and reporting.</li><li>Communicates issues and findings in a concise and timely manner.</li><li>Serves as subject matter expert in assigned areas and cross training initiatives. </li><li>Responsible for the overall communication and collaboration with interdepartmental personnel, leadership, and delegates.</li><li>Identifies areas where technical solutions would improve business performance.</li><li>Consults across business operations, providing mentorship, and contributing specialized knowledge.</li><li>Ensures that the facts and details are correct so that the project's/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices.</li><li>Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</li><li>Performs other duties as assigned.</li></ul>Education Required Associate's Degree In lieu of degree, equivalent education and/or experience may be considered. Experience Required: At least 5 years of experience performing financial audits with the demonstrated experience on the following list of stated knowledge/experience: Skills Required: <ul><li>Must be self-motivated.</li><li>Detail-oriented.</li><li>Excellent verbal and written communication skills.</li><li>Strong analytical and critical thinking skills.</li><li>Able to prioritize assignments, and able to independently with minimum supervision.Ability to interface professionally with both internal and external customers at all levels of the organization.</li><li>Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint).</li><li>Must also have flexible mode of transportation for considerable amount of travel to work off-site.</li></ul><ul><li>Preferred: Healthcare experience Financial audits Financial analysis</li></ul>Licenses/Certifications Required At least one of the following: Certified Public Account (CPA) or Certified Internal Auditor (CIA) or Cerfitified Fraud Examiner (CFE) or Certified Information Systems Auditor (CISA) Additional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including <ul> <li>Paid Time Off (PTO)</li> <li>Tuition Reimbursement</li> <li>Retirement Plans</li> <li>Medical, Dental and Vision</li> <li>Wellness Program</li> <li>Volunteer Time Off (VTO)</li></ul>

Financial Compliance Auditor III Finance

Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Delegation Oversight Compliance Auditor III is responsible for planning, coordination, and conducting comprehensive compliance audits and reviews to assess adherence to regulatory requirements, contractual obligations, and internal policies for L.A. Care subcontracted providers. Additionally, the Auditor III will provide updates and recommendations to Management on quality and delegation oversight responsibilities, participate in fraud, waste, and abuse investigations as applicable, and oversee pre-delegation and annual audits for new and existing delegated entities to drive continuous improvement and adherence to regulatory standards by ensuring delegates are compliant with regulatory requirements. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff. Duties Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project's/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed. Regulatory: Researches, analyzes, and interprets contractual, state, and federal regulatory, and accreditation requirements. Stays abreast of changes in healthcare regulations, laws, and industry standards; analyzes regulatory developments and assesses their impact on the organization. Updates existing audit tools and creates audit tools based on the regulatory requirements. Assists management team with informing team of regulatory changes to ensure alignment with regulatory requirements and industry best practices. Audit: Plans, coordinates, and conduct with other auditors and conducts comprehensive compliance audits and reviews to assess adherence to regulatory requirements, contractual obligations, and internal policies for L.A. Care subcontracted providers including, but not limited to, Participating Physician Groups, Plan Partners, and Specialty Health Plans/Vendors. Independently conducts complex audits, including scoping, research, tool development, field work, reporting, and corrective action plan validation. Identifies, documents, and trends audit issues and provides appropriate coaching and shares best practices with delegated entities to assist with performance improvement. Investigate and Risk Assessment: Investigates and escalates allegations of non-compliance, fraud, or misconduct; develops and implements corrective action plans to address identified issues and prevent recurrence. Conducts risk assessments to identify compliance risks and develops strategies to mitigate risks and strengthens internal controls. Alerts management of identified new or emerging compliance risks and makes recommendations on DOA's audit plan or monitoring plan to other business unit. Serves as a subject matter expert in compliance auditing, risk assessment, risk mitigation planning and regulatory interpretation and application. Duties Continued Collaboration: Leads entrance calls, exit conferences, and technical calls with delegates. Collaborates with cross-functional teams, including but not limited to Legal, Compliance, Quality Assurance to address compliance-related challenges and delegate's performance deficiencies, and implement effective solutions. Assists management to establish processes to track program effectiveness; monitor and analyze data to identify trends and areas for improvement. Works closely with Delegation Oversight Audit management on and to co-lead projects. Reports: Prepares and presents comprehensive reports and presentations to senior leadership, internal Committees, external entities, summarizing compliance activities, findings, and recommendations. Reviews and provides feedback on work papers of other Auditors to ensure accurate testing, results, and reports, and to ensure adherence to departmental procedures and protocols. Training: Develops and delivers compliance training programs for internal staff members, such as Delegation Oversight Audit team, and other business units within L.A. Care. In addition, to develop training programs for delegates as external entities ensuring awareness of compliance requirements and promoting a culture of compliance throughout the organization and with delegates. Leads and manages compliance projects and initiatives, auditors' trainings. Develops training materials, updates audit tools, performs risk assessments, policy development, and process improvement efforts. Perform other duties as assigned. Education Required Bachelor's Degree in Healthcare Administration or Related Field In lieu of degree, equivalent education and/or experience may be considered. Education Preferred Experience Required: At least 4 years of audit experience in compliance, delegation oversight, or audit within the healthcare industry. Demonstrated experience developing and delivering training programs and making presentations to internal staff and providers. Experience in health care service plans with significant delegation arrangements. Experience working with Policies and Procedures. Skills Required: Ability to manage multiple priorities, projects and meet deadlines. Superior written and verbal communication skills. Ability to draft policies and procedures. Exceptional analytical and problem-solving skills, with a meticulous attention to detail. Strong communication and collaboration abilities, with the capacity to engage effectively with stakeholders at all levels. Ability to create a work environment that fosters team building and encourages a collaborative approach to achieving departmental and organizational goals. Proficient in Microsoft Office, Excel, and PowerPoint. In-depth knowledge of federal and state laws, Medicaid regulations, and healthcare compliance standards. Licenses/Certifications Required Licenses/Certifications Preferred Certified HealthCare Compliance (CHC) Required Training Physical Requirements Light Additional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including <ul> <li>Paid Time Off (PTO)</li> <li>Tuition Reimbursement</li> <li>Retirement Plans</li> <li>Medical, Dental and Vision</li> <li>Wellness Program</li> <li>Volunteer Time Off (VTO)</li></ul>

Delegation Oversight Compliance Auditor III

Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Financial Compliance Auditor III Claims is responsible for various tasks within the Financial Compliance Unit, including audit of claims processed by medical groups and health plans contracted with L.A. Care. This role works closely with the Supervisor and/or Lead Auditor on identification and resolution of issues in a timely and efficient manner. For Claims Emphasis: This position is responsible for all aspects of assigned claim audits, including audit testing and completion of the audit report. This position is responsible for a variety of complex areas of the Medi-Cal, Medicare, Covered California, and PASC-SEIU benefit and process. This position audits focuses on contractual and regulatory compliance with timeliness and appropriateness standards. This position is responsible for other ongoing tasks as assigned by the Manager of Financial Compliance. These assignments may include claims data reporting in the Online Monitor Tool (OMT), compiling Monthly Timeliness Report (MTR), completion of the financial statement analysis, and Plan Partner oversight of their Independent Practice Association (IPA) network on a quarterly &amp; annual basis. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. Duties Perform auditing procedures under minimal supervision during the audits of medical groups and health plans. Provide timely and accurate reports that detail whether medical groups and health plans are meeting certain regulatory and contractual requirements. Communicate issues and findings that would affect the audit results. Perform claims audits for all medical groups and health plans contracted with L.A. Care. Timely audit reports presented to supervisor with one week of the audit date. Communicate issues and findings that would affect the audit results. Perform analysis of medical groups and plan partners. Set up financial audit work papers. Perform certain administrative functions for the audit team. Set up completely and timely work papers needed prior to going on site for the claims audits. Perform other duties as assigned. Duties Continued Education Required Bachelor's Degree In lieu of degree, equivalent education and/or experience may be considered. Education Preferred Master's Degree Experience Required: A minimum of 5 years of experience performing claims audits or claims processing related to Medi-Cal, Cal MediConnect, and/or other managed care product lines similar to L.A. Care's, L.A. Care Covered, and PASC-SEIU programs. Skills Required: Must be self-motivated. Detail-oriented. Able to prioritize assignments, and able to work as part of a team. Excellent verbal and written communication skills. Ability to interface professionally with both internal and external customers at all levels of the organization. Must also have flexible mode of transportation for considerable amount of travel to work off-site. Knowledge and understanding of legislation and regulatory bodies affecting healthcare practices. Knowledge of medical records systems applications. Knowledge of the insurance industry's trends, directions, major issues, regulatory considerations and trendsetters. Knowledge of health insurance products, market segments and marketplaces. Additional Information Delegates: This position also conducts sub-delegation claims oversight audit of the PPGs, capitated hospitals and the Plan Partners. This includes all claims processing sub-contracting functions of the delegates. Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including <ul> <li>Paid Time Off (PTO)</li> <li>Tuition Reimbursement</li> <li>Retirement Plans</li> <li>Medical, Dental and Vision</li> <li>Wellness Program</li> <li>Volunteer Time Off (VTO)</li></ul>

3 Audit Jobs in Los Angeles, CA, USA