Delegation Oversight Compliance Auditor III

Duties

• 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 Research

• 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 Conducts

• Plans, coordinates, and conducts comprehensive compliance audits and reviews to assess adherence to regulatory requirements, contractual obligations, and internal policies for L.A. Care subcontracted providers.
• 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.

Collaboration

• Leads entrance calls, exit conferences, and technical calls with delegates.
• Collaborates with cross-functional teams, including but not limited to Legal, Compliance, Quality Assurance to address compliance-related challenges and delegate’s performance deficiencies, and implement effective solutions.
• Assists management to establish processes to track program effectiveness; monitor and analyze data to identify trends and areas for improvement.
• Works closely with Delegation Oversight Audit management on and to co-lead projects.

Reports

• Prepares and presents comprehensive reports and presentations to senior leadership, internal Committees, external entities, summarizing compliance activities, findings, and recommendations.
• Reviews and provides feedback on work papers of other Auditors to ensure accurate testing, results, and reports, and to ensure adherence to departmental procedures and protocols.

Training

• Develops and delivers compliance training programs for internal staff members, such as Delegation Oversight Audit team, and other business units within L.A. Care.
• In addition, to develop training programs for delegates as external entities ensuring awareness of compliance requirements and promoting a culture of compliance throughout the organization and with delegates.
• Leads and manages compliance projects and initiatives, auditors’ trainings.
• Develops training materials, updates audit tools, performs risk assessments, policy development, and process improvement efforts.