Financial Compliance Auditor III

Job Summary

The Financial Compliance Auditor III Finance is a hybrid role and is responsible for various tasks within the Financial Compliance Unit which include but not limited to performing reporting and corrective action plan monitoring of financial solvency reviews of plan partners participating provider groups capitated hospitals specialty health plans and vendors contracted with L.A. Care.

This position is responsible for the overall financial solvency compliance on-going monitoring of assigned delegates across all lines of business including Medi-Cal Covered California D-SNP and PASC-SEIU.

This role works closely with the Manager and other team members on the identification and resolution of issues in a timely and efficient manner. This position leads assigned audits 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 on-going communication collaboration and issue resolution on financial solvency issues with interdepartmental personnel key stakeholders and delegates.

Serves as a subject matter expertand mentor for other staff. #LI-Hybrid

Duties

• This position is responsible for 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.
• Provides timely and accurate deliverables to ensure financial solvency compliance with regulatory and contractual requirements for plan partners participating provider groups capitated hospitals specialty health plans and vendors.
• Supports the design implementation and reporting of special projects such as Medical Loss Ratio.
• Supports the design and implementation of reports and tools for corrective action plan issuance and non-compliance notifications.
• Supports the assessment communication implementation of regulatory requirements that may impact internal processes.
• Supports the formalization of key internal processes and monitoring tools with desktop procedures and applicable policies and procedures development.
• Responsible for the financial audit teams pre-delegation reviews and delivers monthly/quarterly request updates to various business units.
• Responsible for the completion and monitoring of monthly membership report.
• Accountable for the completion of requests from Legal Department Delegation Oversights monitoring oversight and reporting.
• Communicates issues and findings in a concise and timely manner.
• Serves as subject matter expert in assigned areas and cross training initiatives.
• Responsible for the overall communication and collaboration with interdepartmental personnel leadership and delegates.
• 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 projects/programs deliverable meets the needs of the department organization and legislations 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.

Education Required

Associates DegreeIn lieu of degree equivalent education and/or experience may be considered.

Experience

Required:
At least 5 years of experience performing financial audits with the demonstrated experience on the following list of stated knowledge/experience:

Skills

Required:

• Must be self-motivated.
• Detail-oriented.
• Excellent verbal and written communication skills.
• Strong analytical and critical thinking skills.
• Able to prioritize assignments and able to independently with minimum to interface professionally with both internal and external customers at all levels of the organization.
• Proficiency in Microsoft Office (Excel PowerPoint and SharePoint).
• Must also have flexible mode of transportation for considerable amount of travel to work off-site.
• Preferred:
  Healthcare experience
  Financial audits
  Financial analysis

Licenses/Certifications Required

At least one of the following:Certified Public Account (CPA) or Certified Internal Auditor (CIA) or Cerfitified Fraud Examiner (CFE) or Certified Information Systems Auditor (CISA)