Specialty Health Plans Auditor III Finance **$5,000 SIGN ON BONUS

Job Summary

The Specialty Health Plans Auditor III Finance role with a Sign-on Bonus of $5,000 is responsible for all aspects of planning, execution, reporting, and corrective action plans monitoring of financial solvency for specialty health plans and vendors. This includes medical, vision, dental, behavioral health, transportation, and telehealth services providers.  These audits are intended to ensure that L.A. Care delegates comply with applicable regulatory requirements and L.A. Care contractual agreements across all lines of business.

Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.

Duties

Performs financial audits and/or financial analyses for Specialty Health Plans on a quarterly and annual basis.

Performs financial analyses for L.A. Care vendors on a quarterly and annual basis.

Provides timely and accurate deliverables to ensure financial solvency compliance with regulatory and contractual requirements for plan partners, participating provider groups, capitated hospitals, specialty health plans, and vendors.

Collaborates in the creation and implementation of standardized audit workpapers and reporting templates.

Is cross trained on financial solvency reviews for Participating Physician Group (PPGs), PPs, and capitated hospitals.

Reviews and updates annually the department’s Policies and Procedures (P&Ps).  Ensures that any new or updated Policy and Procedure is reviewed and approved by management prior to submission. 

Supports the formalization of key internal processes and monitoring tools.

Accountable for the completion of requests from Legal Department, Delegation Oversight’s monitoring oversight and reporting.

Responsible for the overall communication and collaboration with interdepartmental personnel, leadership, specialty health plans, and vendors.

Duties Continued

Collaborates on the design, implementation, and reporting of special projects.

Collaborates on the design and implementation of reports and tools for corrective action plan issuance and non-compliance notifications.

Collaborates on the assessment, communication, and implementation of regulatory requirements that may impact internal processes.

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.

Performs other duties as assigned.

Education Required

Education Preferred

Experience

Required:

At least 4 years of experience in conducting financial audits.  

At least 5 years of related experience in the managed health care industry.  

Skills

Required:

Excellent analytical and critical thinking skills.

Action-oriented, self-starter, and excellent motivator.

Excellent verbal and written communication skills.

Able to prioritize assignments, and able to independently with minimum supervision.

Ability to interface professionally with both internal and external customers at all levels of the organization.

Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint).