Delegation Oversight Compliance Auditor III

Delegation Oversight Compliance Auditor III

Job Category:
Administrative, HR, Business Professionals

Department:
Compliance

Location:

Los Angeles, CA, US 90017

Position Type:
Full Time

Requisition

Salary Range: $88,854.00 (Min.) – $ (Mid.) – $ (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.

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.

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.

Leads entrance calls, exit conferences, and technical calls with delegates. Collaborates with cross-functional teams,…