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
Job Category:
Customer Service
Location:
Los Angeles, CA, US, 90017
Position Type:
Full Time
Requisition ID:
11036
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.
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 the following end-to-end processes within CSC: Enrollment processing timeliness and accuracy, timeliness of I.D. Card and member materials, outbound health risk assessment (HRA) calls, call documentation and categorization, service authorization request and coverage determination, Appeals and Grievances across all lines of business. This position will maintain CSC's compliance program efforts, including policy and procedure development, training, and compliance programmatic enhancements.
This position will complete targeted audits related to member interactions and outcomes to ensure compliance. Results will be provided to management with recommendations for corrective actions. This position will be responsible for regulatory obligations for each line of business including California Department of Health Care Services (DHCS), Department of Public Social Services (DPSS), Centers for Medicare and Medicaid Services (CMS), and National Committee for Quality Assurance (NCQA).
Duties Audit readiness:
Performs audit procedures for Customer Solution Center departments to ensure readiness; including identifying and defining issues, developing criteria, reviewing evidence, and documenting processes. Conducts interviews, reviews documents, and prepares working papers. Communicates results of audits via written reports and presentations to management.
Regulatory compliance:
Works closely with management to assess operational processes and collaborates with internal Subject Matter Experts (SMEs) to identify deficiencies and recommend process improvements.
Collaborates with Business Analysts to track and analyze results of Quality Assurance (QA) scorecards 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 experience in regulatory auditing in a healthcare environment.
Previous experience with Medi-Cal and Medicare in a managed care environment.
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.
Additional Information This position requires work after hours, on weekends, and holidays, with a hybrid remote schedule and occasional flexibility in hours/shift.
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 Reimbursement
Retirement Plans
Medical, Dental, and Vision
Wellness Program
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Customer Service
Location:
Los Angeles, CA, US, 90017
Position Type:
Full Time
Requisition ID:
11036
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.
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 the following end-to-end processes within CSC: Enrollment processing timeliness and accuracy, timeliness of I.D. Card and member materials, outbound health risk assessment (HRA) calls, call documentation and categorization, service authorization request and coverage determination, Appeals and Grievances across all lines of business. This position will maintain CSC's compliance program efforts, including policy and procedure development, training, and compliance programmatic enhancements.
This position will complete targeted audits related to member interactions and outcomes to ensure compliance. Results will be provided to management with recommendations for corrective actions. This position will be responsible for regulatory obligations for each line of business including California Department of Health Care Services (DHCS), Department of Public Social Services (DPSS), Centers for Medicare and Medicaid Services (CMS), and National Committee for Quality Assurance (NCQA).
Duties Audit readiness:
Performs audit procedures for Customer Solution Center departments to ensure readiness; including identifying and defining issues, developing criteria, reviewing evidence, and documenting processes. Conducts interviews, reviews documents, and prepares working papers. Communicates results of audits via written reports and presentations to management.
Regulatory compliance:
Works closely with management to assess operational processes and collaborates with internal Subject Matter Experts (SMEs) to identify deficiencies and recommend process improvements.
Collaborates with Business Analysts to track and analyze results of Quality Assurance (QA) scorecards 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 experience in regulatory auditing in a healthcare environment.
Previous experience with Medi-Cal and Medicare in a managed care environment.
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.
Additional Information This position requires work after hours, on weekends, and holidays, with a hybrid remote schedule and occasional flexibility in hours/shift.
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 Reimbursement
Retirement Plans
Medical, Dental, and Vision
Wellness Program
#J-18808-Ljbffr