Financial Compliance Auditor III, Finance

Bright Vision Technologies•Los Angeles, CA

About The Position

Bright Vision Technologies is a forward-thinking software development company dedicated to building innovative solutions that help businesses automate and optimize their operations. We leverage cutting-edge technologies to create scalable, secure, and user-friendly applications. As we continue to grow, we’re looking for a skilled Financial Compliance Auditor III, Finance to join our dynamic team and contribute to our mission of transforming business processes through technology. This is a fantastic opportunity to join an established and well-respected organization offering tremendous career growth potential. The Specialty Health Plans Auditor III, Finance is responsible 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 are in compliance 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.

Requirements

Bachelors Degree in Field of Study I: Accounting /Field of Study 2: Finance
At least 4 years of experience in conducting financial audits.
At least 5 years of related experience in the managed health care industry.
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).
Certified Public Accountant (CPA) or
Certified Internal Auditor (CIA) or
Certified Fraud Examiner (CFE) or
Certified Management Accountant (CMA)

Nice To Haves

Masters Degree
Health Care experience.

Responsibilities

Performs financial audits and/or financial analyses for Specialty Health Plans on the quarterly and annual basis.
Performs financial analyses for L.A. Care vendors on the quarterly and annual basis.
Provides timely and accurate deliverables to ensure financial solvency and claims processing 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 workpaper 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.
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.