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Financial Compliance Auditor II

Recruiter
L.A. Care Health Plan
Location
Los Angeles
Salary
Competitive
Closing date
12 Feb 2023

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Employer Sector
Accountancy Practice
Contract Type
Permanent
Hours
Full Time
Travel
None
Job Type
Compliance, Compliance & Regulation

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Job Category: Accounting/Finance

Location:

Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 9023

Salary Range: $67,186.00 (Min.) - $82,108.00 (Mid.) - $107,498.00 (Max.)

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.

As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.

Job Summary

The Financial Compliance Auditor II will assist the Financial Compliance Supervisor and the senior auditors in the completion of medical group and health plan audits, both internally and at site locations. This position will be responsible for performing audits of claims processed by medical groups and health plans contracted with L.A. Care. This position may also be responsible for reporting data in the Online Monitor Tool (OMT) and compiling Monthly Timeliness Report (MTR) on a quarterly basis. This position may also be assigned to compile PPG annual audit results from contracted Health Plans for oversight review and other duties as assigned by the Manager of Financial Compliance on an as needed basis.

Duties


Perform auditing procedures under supervision during the financial audits of medical groups and health plans. Provide timely and accurate reports that detail whether medical groups and health plans are meeting certain regulatory and contractual requirements. (35%)

Perform claims audits for all medical groups and health plans contracted with L.A. Care. Timely audit reports presented to supervisor within one week of the audit date. (35%)

Set up claims and financial audit work papers. Perform certain administrative functions for the audit team. Timely set up complete work papers needed prior to going on site for the financial and claims audits. Compile Plan Partners' audit results of their PPG network for oversight review. Timely and accurately reports to supervisor whether Plan Partners are compliant with PPGs oversight per L.A. Care's Policy & Procedures. (10%)

Perform financial analysis of medical groups and plan partners. Quarterly reports that analyze compliance with certain financial ratios. (10%)

Perform other duties as assigned. (10%)

Education Required

Associate's Degree in Accounting or Finance

In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred Experience

Required:
At least 4 years of accounting experience or in conducting financial audit in various industries.

Experience in conducting medical group and health plan hospital and professional claims audits.

Skills

Required:
Knowledge of and ability to manage the major responsibilities, accountabilities, and organization of the Audit and Compliance (A&C) function or department.

Knowledge of and ability to create, implement, evaluate and enhance internal control processes.

Knowledge of and ability to employ internal controls and to enhance business strategies for the purpose of detecting, correcting and preventing fraudulent activities.

Knowledge of the methods, processes, and tools for maintaining the books of the organization and preparing financial statements and reports.

Strong analytical and critical thinking skills.

Excellent verbal and written communication and presentation skills.

Ability to understand different business needs.

Ability to Make Independent Decisions.

Licenses/Certifications Required Licenses/Certifications Preferred

Certified Public Accountant (CPA)

Required 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

At L.A. Care, we value our team members' safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.

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