Financial Compliance Auditor III Claims

Financial Compliance Auditor III Claims

Job Category: Accounting/Finance

Location: Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 11887

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.

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.

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. This position is responsible for all aspects of assigned claim audits, including audit testing and completion of the audit report, with a focus on contractual and regulatory compliance.

Duties

1. Perform auditing procedures under minimal supervision during the audits of medical groups and health plans.
2. Provide timely and accurate reports that detail whether medical groups and health plans are meeting certain regulatory and contractual requirements.
3. Communicate issues and findings that would affect the audit results.
4. Perform claims audits for all medical groups and health plans contracted with L.A. Care.
5. Timely audit reports presented to supervisor within one week of the audit date.
6. Perform analysis of medical groups and plan partners.
7. Set up financial audit work papers and perform certain administrative functions for the audit team.
8. Perform other duties as assigned.

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.

Skills

Required:

• Must be self-motivated.
• Detail-oriented.
• Able to prioritize assignments and 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.
• 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.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Light

Additional Information

Delegates: This position also conducts sub-delegation claims oversight audit of the PPGs, capitated hospitals and the Plan Partners.

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:

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program