Manager, Financial Compliance Audit

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Job Category:
Accounting/Finance

Location:

Los Angeles, CA, US, 90017

Position Type:
Full Time

Requisition

Salary Range:$(Min.) -$(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 Manager, Financial Compliance Audit (Finance) is is offering a $10,000 Sign On Bonus. This role is responsible for a variety of complex areas in the Medi-Cal, D-SNP, LACC, PASC-SEIU, and Medicare benefit and processes. This position manages the financial audit team in ensuring the delegates such as plan partners, PPGs, & capitated hospitals, etc. adhere to contractual agreements, applicable laws & regulations, policies, and industry standards.

This role is responsible for planning and executing financial solvency audits to meet the audit calendar and reporting requirements. The position manages the quarterly/annual financial analysis to ensure delegates are financially solvent. The Manager monitors the plan partners' oversight activities of their Medi-cal provider network. The position provides guidance based on generally accepted accounting principles that is generally accepted auditing standards of state and federal regulatory requirements for CMS, DHCS and DMHC.

Collaborates with cross-functional business units to identify and address non-compliance audit issues.

Manages all aspects of running an efficient team, including hiring, supervising, coaching, training, annual performance reviews, disciplining, and motivating direct reports.

Manage staff, including, but not limited to 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.

Develop goals, objectives and actions plans for assigned staff, which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.

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

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

Monitor and analyze membership data by delegate on a monthly basis to assign the annual claim processing and financial solvency audits, adherence to regulatory requirements.

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

Develop, implement and execute the audit program and audit procedures for updates and/or changes in the agreement and applicable regulations.

Oversee the comprehensive financial analysis on a quarterly and annual basis to ensure Plan Partner (PPs), Participating Physician Groups (PPGs), and capitated hospitals comply with the financial solvency requirements. Request and follow-up on CAP for non-compliant issues.

Monitor the plan partners' audit and quarterly financial analysis of their Medi-cal provider network

Provide data and information to other business units and management as need.

Communicate effectively with Director of Financial Compliance regarding compliance matters from audits or quarterly financial statements analysis including recommendations and corrective action plans requirements.

Maintain related company's policies and procedures ensuring…