L.A. Care Health Plan
Customer Solution Center Compliance Audit Specialist II
L.A. Care Health Plan, Los Angeles, California, United States, 90079
Customer Solution Center Compliance Audit Specialist II
Job Category:
Customer ServiceLocation:
Los Angeles, CA, US, 90017Position Type:
Full TimeRequisition ID:
11036Salary Range:
$88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan, serving more than 2 million members in five health plans.Mission:
L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of the guidelines and protocols to ensure readiness for all regulatory audits. This position will develop, with the assistance of CSC management, a successful auditing strategy for various end-to-end processes within CSC, including enrollment processing, I.D. card issuance, health risk assessment calls, call documentation, service authorization requests, and appeals and grievances.This position will complete targeted audits related to member interactions and outcomes to ensure compliance, providing results and recommendations to management. It will also be responsible for adhering to regulatory obligations for each line of business and preparing reports on findings.Duties
Audit readiness:
Perform audit procedures for Customer Solution Center departments to ensure readiness, including identifying and defining issues, developing criteria, reviewing evidence, and documenting processes.Regulatory compliance:
Work closely with management to assess the effectiveness of operational processes and collaborate with internal SMEs to address deficiencies.Collaborate with the Business Analyst to track and analyze QA scorecard results for training and quality improvement.Perform other duties as assigned.Education Required
Bachelor's Degree. In lieu of degree, equivalent education and/or experience may be considered.Experience
Required:
A minimum of 5 years of experience in regulatory auditing in a healthcare environment, including experience with Medi-Cal and Medicare in a managed care setting.Skills
Required:Advanced computer proficiency in Word, Excel, and Access.Strong analytical and team-building skills.Ability to work effectively with diverse team members.Ability to formulate recommendations for quality and service delivery improvements.Ability to multi-task and streamline operations.Strong interpersonal and organizational skills.Physical Requirements
LightAdditional Information
This position requires work after hours, on weekends, holidays, a hybrid remote schedule, and flexibility in hours/shift in critical situations.Salary Range Disclaimer:
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.L.A. Care offers a wide range of benefits including:Paid Time Off (PTO)Tuition ReimbursementRetirement PlansMedical, Dental and VisionWellness Program
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Job Category:
Customer ServiceLocation:
Los Angeles, CA, US, 90017Position Type:
Full TimeRequisition ID:
11036Salary Range:
$88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan, serving more than 2 million members in five health plans.Mission:
L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of the guidelines and protocols to ensure readiness for all regulatory audits. This position will develop, with the assistance of CSC management, a successful auditing strategy for various end-to-end processes within CSC, including enrollment processing, I.D. card issuance, health risk assessment calls, call documentation, service authorization requests, and appeals and grievances.This position will complete targeted audits related to member interactions and outcomes to ensure compliance, providing results and recommendations to management. It will also be responsible for adhering to regulatory obligations for each line of business and preparing reports on findings.Duties
Audit readiness:
Perform audit procedures for Customer Solution Center departments to ensure readiness, including identifying and defining issues, developing criteria, reviewing evidence, and documenting processes.Regulatory compliance:
Work closely with management to assess the effectiveness of operational processes and collaborate with internal SMEs to address deficiencies.Collaborate with the Business Analyst to track and analyze QA scorecard results for training and quality improvement.Perform other duties as assigned.Education Required
Bachelor's Degree. In lieu of degree, equivalent education and/or experience may be considered.Experience
Required:
A minimum of 5 years of experience in regulatory auditing in a healthcare environment, including experience with Medi-Cal and Medicare in a managed care setting.Skills
Required:Advanced computer proficiency in Word, Excel, and Access.Strong analytical and team-building skills.Ability to work effectively with diverse team members.Ability to formulate recommendations for quality and service delivery improvements.Ability to multi-task and streamline operations.Strong interpersonal and organizational skills.Physical Requirements
LightAdditional Information
This position requires work after hours, on weekends, holidays, a hybrid remote schedule, and flexibility in hours/shift in critical situations.Salary Range Disclaimer:
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.L.A. Care offers a wide range of benefits including:Paid Time Off (PTO)Tuition ReimbursementRetirement PlansMedical, Dental and VisionWellness Program
#J-18808-Ljbffr