Director, Financial Compliance

L.A. Care Health Plan•Los Angeles, CA

6d•Onsite

About The Position

The Director of Financial Compliance is responsible for a variety of complex areas in the Medi-Cal, D-SNP, PASC-SEIU, and Medicare benefit and process. This position directs the audit team on all aspects of health plans, capitated hospitals, and medical groups’ financial solvency audits, claims audits, quarterly/annual financial analysis, Online Monitoring Tool (OMT) and Monthly Timeliness Report (MTR) reporting. This includes audit planning, audit assignments, and ensuring completion of audit calendar and reporting. This position measures auditee compliance with appropriate Federal and State regulatory standards and prepares summary reports of findings for the Sr. Director of Financial Compliance and for distributions internally & externally. In addition, this position provides guidance based on generally accepted accounting principles, generally accepted auditing standards, Centers for Medicare and Medicaid Service (CMS), California Department of Health Care Service (DHCS), and California Department of Managed Health Care (DMHC) regulatory requirements as well as L.A. Care's service contract agreement with its provider network; conduct final review of staff audit work to ensure quality deliverables; resolve variety of complex audit issues; develop staff training plan and deliver periodic staff performance evaluations; and communicate requirements and standards to network as necessary. The Director of Financial Compliance works with L.A. Care participating Plan Partners on the collaboration of financial solvency & Medi-Cal claims audit process, and overseeing the completion of these audit assignments. This position is responsible for the oversight of L.A. Care Plan Partners audits of their Medi-cal provider network. This position regularly supports the Compliance Department on various requests for CMS and DMHC/DHCS audits. These audits include but not limited to the CMS/Advent annual Medicare Data Validation Audit (MDVA) & Organization Determination, Appeals & Grievances (ODAG) audit. Various detailed functions are involved in the preparation of these audits, which include but not limited to quarterly reporting of the First Team Entity Auditing & Monitoring (FTEAM) activities to the Compliance Department, overseeing the collection of monthly Medicare claims data from all the contracted Medicare Cal-MediConnect (CMC) medical groups and capitated hospitals, and involvement in the decision making of new process implementation of any CMS reporting specification & protocol updates. To prepare for CMS annual audits, Mock CMS audits with the Burchfield Group and Gorman Health Group are required to be supported including Corrective Action Plans (CAP) as necessary with CMC contracted providers. The Director directs all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.

Requirements

At least 7 years of financial auditing, and claims audits related to Medi-Cal and other managed care product lines or related experience with 5 years of managerial audit and/or financial solvency experience.
Leadership experience in organizing, planning and executing projects from conceptualization through implementation across multiple internal and external reporting and organizational lines.
At least 5 years leading staff or supervisory/management experience.
Must be able to handle the growing population in the L.A. Care network and audit activities.
Excellent verbal and written communication skills.
Ability to interface professionally with both internal and external customers at all levels of the organization.
Ability to discuss and explain highly technical financial issues with non-financial professionals.
Strong analytical and problem solving skills.
Strong attention to detail, demonstrated integrity and professionalism.
Excellent project managerial and interpersonal skills.
Ability to motivate teams to produce quality materials within tight timeframes and simultaneously manage several projects required.
Proven ability to perform under pressure and stress and to adjust plans to meet changing needs and requirements.
Demonstrated ability to facilitate and coordinate multiple deadlines, create cohesive teams, and respond quickly to management requests.

Nice To Haves

Master's Degree
Certified Public Accountant (CPA)

Responsibilities

Manages staff to ensure completeness on the analysis of Plan Partners’ audit of their provider network.
Follow-up on the corrective action plan for the non-compliant audit results.
Oversight of Plan Partners’ audit of their provider network.
Develops goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.
Prepares briefings, reports, consultation documents and presentations that clearly articulate L.A. Care's regulatory position and policy.
Develops regulatory position and policy based on research and evidence.
Streamlines audit process to ensure audit efficiency and completion of audit calendar.
Responsible for the schedule of audit fieldwork and staff assignments.
Manages the financial solvency and claims audit to ensure successful completion of audit calendar and enhance performance quality.
Requests and follows up on CAP.
Schedules and manages the Medi-cal ER claims follow-up audit to assess the medical groups and/or capitated hospital’s implementation of the Corrective Action Plans.
Performs the second review and approval of audit work paper, communicates audit issues, and timely reports audit results to the Director of Financial Compliance & Regulatory Affairs and Compliance.
Responsible for the focus audits, special audits, and analytic support to provide management with information necessary to make tactical and strategic decisions.
Perform other duties as assigned.