Customer Solution Center Enrollment Quality Control Auditor II (Temporary)

Job Category:  Administrative, HR, Business Professionals
Department:  Enrollment Services
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  5044

 

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 Customer Solution Center Enrollment Quality Control Auditor II is responsible for auditing process analysis and evaluation. This position will participate in implementing the process enhancements that will facilitate the optimal performance of the department processes and functions.  

Duties

Conduct research and comprehensive analyses to aide in departmental and organizational goals, initiatives, and decision making. Perform the validation of various standard and ad hoc reports, auditing of member eligibility, assignment, and demographic information, and/or audit materials related to mailing fulfillments. Collaborate closely with the Membership Information Supervisor, Senior Report Writers/Analysts, and various other internal and external stakeholders to implement new databases, queries, and reports (and update existing ones) to help facilitate the timely, accurate reflection of membership information for all lines of business in the systems, in accordance with regulatory and organizational guidelines. (35%)

 

Compile, prepare, and present various related reports, analyses, summaries, and correspondence to aid in management decision-making, implementation of systems and process enhancements, etc.
Collaborate cross-functionally with external stakeholders, consultants, and vendors as well as internal staff on the review/update of business and technical requirements documents, user acceptance testing; etc. (30%)

 

Recommend process solutions and enhancements to management. Facilitate in the  implementation of approved systems and process solutions/ enhancements. (25%)

 

Perform other duties as assigned. (10%)

Education Required
High School Diploma/or High School Equivalency Certificate
Education Preferred
Associate's Degree in Health Administration or Business Administration
Experience


Required:
At least 0-1 years of quality control auditor or auditing experience in a managed care or healthcare field setting.

 

Experience with and knowledge on Medi-Cal, Medicare, Market Place/Exchange, Commercial and Individual lines of business and other related government-funded/sponsored healthcare programs which include, but not limited to TRR, HCO or 834 electronic files.

 

Project management experience

Skills


Required:
Intermediate computer skills (including Microsoft Access, Excel, Word, and PowerPoint).

 

Excellent customer service and membership processing systems such as QNXT, MHC, or MHS.

 

Strong analytical and problem-solving skills.

 

Strong organizational skills.

 

Strong interpersonal, verbal, and written communication skills.

 

Strong leadership, team-building, customer service, and presentation skills.

Licenses/Certifications Required
Licenses/Certifications Preferred
Project Management Professional (PMP)
Required Training

Preferred:
Customer Service Training

Additional Information

 

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: Audit, Medical, Medicare, Finance, Healthcare