Claims Compliance Coordinator

Job Category:  Claims
Department:  Claims
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  3501

 

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 in five health plans, 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.

Job Summary

The Claims Compliance Coordinator supports the collection of Medicare ODAG data from L.A. Care’s PPG and Plan Partners.  The Compliance Coordinator is responsible to ensure that all PPG and Plan Partner data is received in the time frame required. This position services as a Key liaison between PPG’s, Plan Partners, and the Compliance Data Analyst. The Claims Compliance Coordinator also ensures that L.A. Care's Claims Department is compliant with all DMHC, Medi-Cal, CMS, federal and state regulations, as well as contractual provisions. This position supports internal and external audits and provides support to the Claims Operation process.  The Claims Compliance Coordinator may also serve as a resource to internal staff and collaborate/participate in some aspects of compliance impacting the Claims department as directed by management.

Duties

Collect PPG and Plan Partner Medicare ODAG data; Provide support researching Regulatory Guidelines; Provide Support during Regulatory Audits; Support reporting with the Online Management tool. (50%)

Participate in internal work teams to support development of data validation; Supports the documentation of complex business requirements and work flows independently or in a team setting; Maintains detailed knowledge of Medicare, Medicare Advantage, and Medicare-Medi-Cal (MMP). (20%)

Support and assist in the development of data validation processes; Support  in ongoing business process improvement for data validation and other required metrics. (20%)

Perform other duties as assigned. (10%)

Education

High School Diploma/GED

Associate's Degree or Bachelor's Degree

Experience

Required:
With High School Diploma: 1-2 years of direct Claims experience.

Skills

Required:
Proficient in Microsoft Office including Word Excel and Outlook.

Strong verbal and written communication skills.

Ability to manage multiple projects and work in a fast-paced, changing environment.

Ability to identify and prioritize tasks, take time to answer questions and follow through on commitments in a timely manner.

Maintains a commitment to continuous improvement.

 

L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)


Nearest Major Market: Los Angeles

Job Segment: Claims, Medical, Medicare, Insurance, Healthcare