Senior Business Analyst, Contracts and Regulatory Oversight

Job Category:  Provider Relations
Department:  Provider Network Management (345)
Location: 

Los Angeles HQ, California, US

Position Type:  Full Time
Requisition ID:  1402

 

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.

DUTIES
Under the general direction of the Senior Manager of Contracts and Regulatory Oversight, the Senior Business Analyst, Contracts and Regulatory Oversight is a critical thinker who is responsible for eliciting, analyzing, communicating, testing and verifying requirements for services delivered through of the L.A. Care (LAC) Provider Network Management (PNM) organization, and the Provider Network Management organizations of LACs contracted Plan Partners. The Senior Business Analyst is responsible for maintaining a subject matter expertise of the operational, reporting, and accrediting requirements for all lines of business (Medicaid, Medicare, and Commercial) and support his or her team in ensuring the LAC PNM organization, and partner with the Executive Director of the Plan Partners line of business to ensure the LAC contracted Plan Partners, are compliant.

The Senior Business Analyst is required to complete and maintain a comprehensive function-based index that codifies contractual, regulatory, accreditation requirements into major categories, stratifies sub-function level requirements for each product line, and leverages the requirements to monitor and oversight the PNM organization, and the LAC contracted Plan Partners.  The Senior Business Analyst is required to utilizing a standardized template to document each requirement identified in the index and its corresponding authority source(s), and utilize a corresponding standardized template to document LAC’s performance with each requirement identified in the index. The completed form would summarize the manner by which LAC demonstrates compliance with the corresponding requirement, e.g., policy, desktop procedures, workflow(s), and internal performance measures.  

QUALIFICATIONS AND REQUIREMENTS

EDUCATION

Required
High School Diploma

Preferred
Bachelor's Degree

EXPERIENCE
Required
Proven ability to work with a diverse group of people, including physicians, support staff, coworkers and management.
Demonstrated ability to research issues and bring about resolution either directly or with the assistance of others.
Demonstrated critical thinking and problem solving skills.
Strong written and verbal communication skills.
Strong elicitation and process documentation skills
Strong organizational and communication skills to build and foster effective relationships.

With High School Diploma: 
7 years of experience in contract and/or regulatory and/or accreditation requirements analysis in managed care or other related health care industry; or, 
7 years of experience in external regulatory or governing entity audit preparation. 

With Associate's Degree:  
4 - 6 years of experience in contract and/or regulatory and/or accreditation requirements analysis in managed care or other related health care industry; or,
4 - 6 years of healthcare experience in external regulatory or governing entity audit preparation. 

With Bachelor's Degree:  
3 - 5 years of experience in contract and/or regulatory and/or accreditation requirements analysis in managed care or other related health care industry; or,
3 - 5 years of healthcare experience in external regulatory or governing entity audit preparation.

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)


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