L.A. Care Health Plan
Customer Solution Center Audit Readiness Specialist II
L.A. Care Health Plan, Los Angeles, California, United States, 90079
Customer Solution Center Audit Readiness Specialist II
Salary 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.
As a condition of employment, L.A. Care requires a COVID-19 vaccine, including for our remote workforce. Exemptions may be requested for documented medical conditions and sincerely held religious beliefs.
Job Summary
The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of guidelines and protocols to ensure readiness for all regulatory audits. This position will develop a successful auditing strategy for various processes within CSC, including enrollment processing, call documentation, service authorization requests, and appeals and grievances.
This position will complete targeted audits related to member interactions and outcomes, providing management with recommendations and corrective actions. The role involves regulatory obligations for each line of business and requires leading audit situations and reporting findings.
Duties
Audit readiness:
Performs audit procedures for Customer Solution Center departments, including identifying issues, developing criteria, reviewing evidence, and documenting processes. Communicates results via written reports and oral presentations.
Regulatory compliance:
Works with management to assess operational processes and collaborates with internal SMEs to address deficiencies. Evaluates policies and procedures against regulations and provides recommendations for improvements.
Collaborates 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 or equivalent education/experience.
Experience Required:
A minimum of 5 years of regulatory auditing experience in a healthcare environment, including Medi-Cal and Medicare in a managed care setting.
Preferred:
Experience with Tableau.
Skills Required:
Advanced proficiency in Word, Excel, and Access; strong analytical and team-building skills; ability to work effectively with diverse teams; ability to formulate recommendations for quality and service delivery improvements; strong interpersonal and organizational skills.
Physical Requirements:
Light
Additional Information
L.A. Care offers a wide range of benefits including:
Paid Time Off (PTO)Tuition ReimbursementRetirement PlansMedical, Dental, and VisionWellness ProgramVolunteer Time Off (VTO)
At L.A. Care, we value our team members' safety. Employees are required to self-screen for symptoms prior to entering any L.A. Care location and comply with state and local masking orders.#J-18808-Ljbffr
Salary 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.
As a condition of employment, L.A. Care requires a COVID-19 vaccine, including for our remote workforce. Exemptions may be requested for documented medical conditions and sincerely held religious beliefs.
Job Summary
The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of guidelines and protocols to ensure readiness for all regulatory audits. This position will develop a successful auditing strategy for various processes within CSC, including enrollment processing, call documentation, service authorization requests, and appeals and grievances.
This position will complete targeted audits related to member interactions and outcomes, providing management with recommendations and corrective actions. The role involves regulatory obligations for each line of business and requires leading audit situations and reporting findings.
Duties
Audit readiness:
Performs audit procedures for Customer Solution Center departments, including identifying issues, developing criteria, reviewing evidence, and documenting processes. Communicates results via written reports and oral presentations.
Regulatory compliance:
Works with management to assess operational processes and collaborates with internal SMEs to address deficiencies. Evaluates policies and procedures against regulations and provides recommendations for improvements.
Collaborates 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 or equivalent education/experience.
Experience Required:
A minimum of 5 years of regulatory auditing experience in a healthcare environment, including Medi-Cal and Medicare in a managed care setting.
Preferred:
Experience with Tableau.
Skills Required:
Advanced proficiency in Word, Excel, and Access; strong analytical and team-building skills; ability to work effectively with diverse teams; ability to formulate recommendations for quality and service delivery improvements; strong interpersonal and organizational skills.
Physical Requirements:
Light
Additional Information
L.A. Care offers a wide range of benefits including:
Paid Time Off (PTO)Tuition ReimbursementRetirement PlansMedical, Dental, and VisionWellness ProgramVolunteer Time Off (VTO)
At L.A. Care, we value our team members' safety. Employees are required to self-screen for symptoms prior to entering any L.A. Care location and comply with state and local masking orders.#J-18808-Ljbffr