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L.A. Care Health Plan · 1 day ago

Manager, Financial Compliance Audit, $10,000 SIGN ON BONUS

Los Angeles, CA

Full-time

Onsite

Mid, Senior Level

$118K/yr - $188K/yr

6+ years exp

L.A. Care Health Plan is the nation’s largest publicly operated health plan, providing health coverage to low-income Los Angeles County residents. The Manager, Financial Compliance Audit is responsible for overseeing financial audits and ensuring compliance with regulations and contractual agreements across various healthcare services.

FitnessGovernmentHealth Care

Responsibilities

Manages all financial solvency related audits and related monitoring activities 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 oversight of 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

Manages staff, including, but not limited to monitoring of day-to-day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others

Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval

Manages and ensures timely and accurate review of deliverables. Ensures financial solvency compliance with regulatory and contractual requirements for plan partners, PPGs, capitated hospitals, specialty health plans, and vendors

Manages the design, implementation, and reporting of special projects such as Medical Loss Ratio

Manages the design and implementation of reports and tools for corrective action plan issuance and non-compliance notifications

Manages the assessment, communication, implementation of regulatory requirements that may impact internal processes. Responsible for the on-going communication, collaboration, and issue resolution on financial solvency issues with interdepartmental personnel, key stakeholders, and delegates

Manages the formalization of key internal processes and monitoring tools with desktop procedures and applicable policies and procedures development

Responsible for the completion and review of financial audit team’s pre-delegation assessment and delivery of monthly/quarterly request updates to various business units

Responsible for the overall communication and collaboration with cross-functional teams, senior leadership, and delegates

Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities

Oversees the monitoring and analysis of membership data by delegates on a monthly basis to assign the annual claim processing and financial solvency audits, adherence to regulatory requirements

Manages complex financial solvency audits to ensure quality deliverables, resolve audit issues, and issuance of final audit reports. Requests and follow-ups on Corrective Action Plans (CAPs) on non-compliant audit results

Develops, implements, and executes the audit program and audit procedures for updates and/or changes in the agreement and applicable regulations

Oversees and reviews the comprehensive financial analysis on a quarterly and annual basis to ensure Plan Partner (PPs), Participating Physician Groups (PPGs), and capitated hospitals, Specialty Health Plans, and vendors comply with the financial solvency requirements. Requests and follow-ups on CAP for non-compliant issues

Monitors the plan partners' audit and quarterly financial analysis of their Medi-Cal provider network

Communicates effectively with senior leadership on compliance matters from audits or quarterly financial statements analysis including recommendations and corrective action plans requirements

Maintains related company's policies and procedures ensuring they are current

Proactively identifies opportunities and solutions to improve the effectiveness and efficiency of the financial audit function

Performs other duties as assigned

Qualification

Financial AuditingManaged Care RegulationsAudit MethodologiesTeam ManagementAnalytical SkillsInternal Control ProcessesCPA CertificationCIA CertificationCMA CertificationCFE CertificationMicrosoft OfficeCommunication SkillsProblem-Solving Skills