Operations Specialist, Experienced

California Physicians' Service • Los Angeles, CA

85d

About The Position

The Delegation Oversight (DO) team, under the purview of the Delegation Oversight Committee (DOC) which is a sub-committee of the Quality Oversight Committee (QOC), is responsible for oversight of contracted delegated entities. This includes auditing, corrective actions follow-up and monitoring activities. The DO team will coordinate with other internal departments on oversight activities. Reporting to the Manager, Delegation Oversight, this role is responsible for documentation of policies and procedures, and oversight of LA Care audits and quality review along with submission of data to compliance. The Operations Specialist, Experienced, is also responsible for working with colleagues on coordination and submission of state reporting to the Department of Managed Health Care (DMHC). This position is responsible for tracking and monitoring monthly, quarterly, and annual reporting timeliness and Provider Dispute Resolution to provide into the DMHC portal reporting. The Operations Specialist, Experienced position also reviews and provides to the DMHC Corrective Action Plans (CAPs) and requests for information.

Responsibilities

• Oversight of contracted delegated entities including auditing and monitoring activities.
• Coordinate with internal departments on oversight activities.
• Document policies and procedures related to delegation oversight.
• Oversee LA Care audits and quality reviews.
• Submit data to compliance.
• Coordinate and submit state reporting to the Department of Managed Health Care (DMHC).
• Track and monitor reporting timeliness (monthly, quarterly, and annual).
• Manage Provider Dispute Resolution reporting to the DMHC portal.
• Review and provide Corrective Action Plans (CAPs) to the DMHC.

What This Job Offers

• Job Type: Full-time
• Industry: Insurance Carriers and Related Activities