Manager, Financial Compliance Audit, $10,000 SIGN ON BONUS

L.A. Care Health Plan•Los Angeles, CA

21d

About The Position

Manager, Financial Compliance Audit (Finance) has a $10,000 SIGN-ON BONUS. This role is responsible for the timely and quality delivery of a variety of complex areas across all lines of business, including Medi-Cal, Covered California, D-SNP, and PASC-SEIU. This position manages the financial audit team in ensuring the delegates such as plan partners, participating provider groups (PPGs), and capitated hospitals, Specialty Health Plans, and vendors contracted with L.A. Care adhere to contractual agreements, applicable laws & regulations, policies, and industry standards which provide medical, hospital, vision, dental, behavioral health, transportation and telehealth services. This position is responsible for planning, executing, reporting, and monitoring financial solvency audits and ensuring meeting the audit calendar and reporting requirements. This position manages the quarterly/annual financial analysis to ensure that delegates are financially solvent. The Manager monitors the plan partners' oversight activities of their Medi-Cal provider network. Manages all aspects of running an efficient and high-performance team, including hiring, supervising, coaching, training, annual performance reviews, disciplining, and motivating direct reports.

Requirements

Bachelor's Degree in Finance or Accounting or Related Field
In lieu of degree, equivalent education and/or experience may be considered.
At least 6 years of experience in financial auditing in a managed care industry.
At least 4 years of leading, supervising and/ or managing staff experience.
Proven experience in leading and managing audit teams.
Significant experience in assessing, investigating, and auditing compliance risks.
Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.
Demonstrated ability to handle the growing population in the L.A. Care network and audit activities.
Excellent verbal and written communication, and presentation skills.
Knowledge of relevant managed care regulations and audit methodologies.
Excellent analytical and problem-solving skills.
Ability to interface professionally with both internal and external customers at all levels of the organization.
Must be self-motivated, detail-oriented, prioritize assignments, and able to work as part of a team.
Knowledge of and ability to oversee the major responsibilities, accountabilities, and organization of the audit and compliance function.
Knowledge of and ability to create, implement, evaluate and enhance internal control processes.
Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint).
Certified Public Accountant (CPA)
Certified Internal Auditor (CIA)
Certified Management Accountant (CMA)
Certified Fraud Examiner (CFE)

Nice To Haves

Master's Degree

Responsibilities

Manages all financial solvency related audits and related monitoring activities independently in accordance with general accepted auditing standards, generally accepted accounting principles (GAAP), regulations of the Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and other federal and state guidelines.
Responsible for the oversight of all aspects of financial solvency reviews including, but not limited to, the planning, execution, continuous monitoring, and reporting of annual financial audits, quarterly and annual financial analyses (ratio and trending analyses), and special projects.
Manages staff, including, but not limited to monitoring of day-to-day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.
Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.
Manages and ensures timely and accurate review of deliverables. Ensures financial solvency compliance with regulatory and contractual requirements for plan partners, PPGs, capitated hospitals, specialty health plans, and vendors.
Manages the design, implementation, and reporting of special projects such as Medical Loss Ratio.
Manages the design and implementation of reports and tools for corrective action plan issuance and non-compliance notifications.
Manages the assessment, communication, implementation of regulatory requirements that may impact internal processes. Responsible for the on-going communication, collaboration, and issue resolution on financial solvency issues with interdepartmental personnel, key stakeholders, and delegates.
Manages the formalization of key internal processes and monitoring tools with desktop procedures and applicable policies and procedures development.
Responsible for the completion and review of financial audit team’s pre-delegation assessment and delivery of monthly/quarterly request updates to various business units.
Responsible for the overall communication and collaboration with cross-functional teams, senior leadership, and delegates.
Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities.
Oversees the monitoring and analysis of membership data by delegates on a monthly basis to assign the annual claim processing and financial solvency audits, adherence to regulatory requirements.
Manages complex financial solvency audits to ensure quality deliverables, resolve audit issues, and issuance of final audit reports. Requests and follow-ups on Corrective Action Plans (CAPs) on non-compliant audit results.
Develops, implements, and executes the audit program and audit procedures for updates and/or changes in the agreement and applicable regulations.
Oversees and reviews the comprehensive financial analysis on a quarterly and annual basis to ensure Plan Partner (PPs), Participating Physician Groups (PPGs), and capitated hospitals, Specialty Health Plans, and vendors comply with the financial solvency requirements. Requests and follow-ups on CAP for non-compliant issues.
Monitors the plan partners' audit and quarterly financial analysis of their Medi-Cal provider network.
Communicates effectively with senior leadership on compliance matters from audits or quarterly financial statements analysis including recommendations and corrective action plans requirements.
Maintains related company's policies and procedures ensuring they are current.
Proactively identifies opportunities and solutions to improve the effectiveness and efficiency of the financial audit function.
Performs other duties as assigned.