Financial Compliance Auditor III Finance

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 Financial Compliance Auditor III Finance 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 position works closely with management 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.

Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.

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.

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.

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

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

Collaborates the assessment, communication, implementation of regulatory requirements that may impact internal processes.

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

Responsible for the financial audit team’s pre-delegation reviews and delivers monthly/quarterly request updates to various business units.

Responsible for the completion and monitoring of monthly membership report.

Accountable for the completion of requests from Legal Department, Delegation Oversight’s monitoring oversight and reporting.

Communicates issues and findings in a concise and timely manner.

Responsible for the overall communication and collaboration with interdepartmental personnel, leadership, and delegates.

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…