Financial Compliance Auditor III Finance

About the role

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.

Responsibilities

• Perform, report, and monitor corrective action plans for financial solvency reviews of plan partners, participating provider groups, capitated hospitals, specialty health plans, and vendors contracted with L.A. Care.
• Conduct ongoing financial solvency compliance monitoring of assigned delegates across Medi-Cal, Covered California, D-SNP, and PASC-SEIU lines of business.
• Lead assigned audits independently in accordance with GAAS, GAAP, DMHC, DHCS, CMS, and other federal and state guidelines.
• Collaborate with management and team members to identify and resolve issues timely and efficiently.
• Communicate and collaborate on financial solvency issues with interdepartmental personnel, key stakeholders, and delegates.
• Act as a Subject Matter Expert, serve as a resource and mentor for other staff.
• Plan, execute, continuously monitor, and report annual financial audits, quarterly and annual financial analyses (ratio and trending analyses), and special projects.
• Provide timely and accurate deliverables to ensure financial solvency compliance with regulatory and contractual requirements.
• Collaborate on design, implementation, and reporting of special projects such as Medical Loss Ratio.
• Collaborate on design and implementation of reports and tools for corrective action plan issuance and non-compliance notifications.
• Assess, communicate, and implement regulatory requirements that may impact internal processes.
• Support formalization of key internal processes and monitoring tools with desktop procedures and applicable policies and procedures development.
• Complete and monitor monthly membership report.
• Complete requests from Legal Department, Delegation Oversight’s monitoring oversight and reporting.
• Communicate issues and findings concisely and timely.
• Apply subject expertise in evaluating business operations and processes; identify areas where technical solutions would improve performance.
• Consult across business operations, providing mentorship and contributing specialized knowledge.
• Ensure facts and details are correct so deliverables meet department, organization, and legislative policies, standards, and best practices.
• Provide training, recommend process improvements, and mentor junior level staff, department interns, etc. as needed.
• Perform other duties as assigned.

Requirements

• Bachelor's Degree in Finance or Accounting or Related Field (equivalent education and/or experience may be considered).
• At least 4 years of experience performing financial audits.
• Preferred Health Care experience.
• Licenses/Certifications Required (any of the following): Certified Public Accountant (CPA), Certified Internal Auditor (CIA), Certified Medical Assistant (CMA), Certified Fraud Examiner (CFE).

Physical Requirements: Light.

Qualifications

• Master's Degree preferred.

Skills

• Self-motivated.
• Detail-oriented.
• Excellent verbal and written communication skills.
• Excellent analytical and critical thinking skills.
• Ability to prioritize assignments and work independently with minimum supervision.
• Ability to interface professionally with internal and external customers at all levels.
• Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint).
• Flexible mode of transportation for considerable amount of travel to work off-site.

Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement