About this role
<p><b>Salary Range: </b> $117,509.00 (Min.) - $152,762.00 (Mid.) - $188,015.00 (Max.)</p> <p> </p> <p>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, we make sure our members get the right care at the right place at the right time.<br> <br> 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.<br> </p> <div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Job Summary</H2> </div><div><p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Manager, Financial Compliance Audit (Finance) has a $10,000 SIGN-ON BONUS. This role is responsible for the timely and quality delivery of a variety of complex areas across all lines of business, including Medi-Cal, Covered California, D-SNP, and PASC-SEIU. </span></span><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">This position manages the financial audit team in ensuring the delegates such as plan partners, participating provider groups (PPGs), and capitated hospitals, Specialty Health Plans, and vendors contracted with L.A. Care adhere to contractual agreements, applicable laws & regulations, policies, and industry standards which provide medical, hospital, vision, dental, behavioral health, transportation and telehealth services. This position is responsible for planning, executing, reporting, and monitoring financial solvency audits and ensuring meeting the audit calendar and reporting requirements. This position manages the quarterly/annual financial analysis to ensure that delegates are financially solvent. The Manager monitors the plan partners' oversight activities of their Medi-Cal provider network. Manages all aspects of running an efficient and high-performance team, including hiring, supervising, coaching, training, annual performance reviews, disciplining, and motivating direct reports. </span></span></p></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Duties</H2> </div><div><p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Manages all financial solvency related audits and related monitoring activities 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.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Responsible for the oversight of 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.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Manages staff, including, but not limited to monitoring of day-to-day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Manages and ensures timely and accurate review of deliverables. Ensures financial solvency compliance with regulatory and contractual requirements for plan partners, PPGs, capitated hospitals, specialty health plans, and vendors.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Manages the design, implementation, and reporting of special projects such as Medical Loss Ratio.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Manages the design and implementation of reports and tools for corrective action plan issuance and non-compliance notifications.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Manages the assessment, communication, implementation of regulatory requirements that may impact internal processes. Responsible for the on-going communication, collaboration, and issue resolution on financial solvency issues with interdepartmental personnel, key stakeholders, and delegates.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Manages the formalization of key internal processes and monitoring tools with desktop procedures and applicable policies and procedures development.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Responsible for the completion and review of financial audit team’s pre-delegation assessment and delivery of monthly/quarterly request updates to various business units.</span></span></p></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Duties Continued</H2> </div><div><p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Responsible for the overall communication and collaboration with cross-functional teams, senior leadership, and delegates.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities. </span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Oversees the monitoring and analysis of membership data by delegates on a monthly basis to assign the annual claim processing and financial solvency audits, adherence to regulatory requirements.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Manages complex financial solvency audits to ensure quality deliverables, resolve audit issues, and issuance of final audit reports. Requests and follow-ups on Corrective Action Plans (CAPs) on non-compliant audit results.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Develops, implements, and executes the audit program and audit procedures for updates and/or changes in the agreement and applicable regulations.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Oversees and reviews the comprehensive financial analysis on a quarterly and annual basis to ensure Plan Partner (PPs), Participating Physician Groups (PPGs), and capitated hospitals, Specialty Health Plans, and vendors comply with the financial solvency requirements. Requests and follow-ups on CAP for non-compliant issues.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Monitors the plan partners' audit and quarterly financial analysis of their Medi-Cal provider network.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Communicates effectively with senior leadership on compliance matters from audits or quarterly financial statements analysis including recommendations and corrective action plans requirements.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Maintains related company's policies and procedures ensuring they are current.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Proactively identifies opportunities and solutions to improve the effectiveness and efficiency of the financial audit function.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:'Calibri', sans-serif">Performs other duties as assigned.</span></span></p></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Education Required</H2> </div><div><div>Bachelor's Degree in Finance or Accounting or Related Field</div><div>In lieu of degree, equivalent education and/or experience may be considered.</div></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Education Preferred</H2> </div><div><div>Master's Degree</div></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Experience</H2> </div><div><p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif"><b>Required:</b></span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">At least 6 years of experience in financial auditing in a managed care industry.</span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"> </p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">At least 4 years of leading, supervising and/ or managing staff experience. </span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"> </p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Proven experience in leading and managing audit teams.</span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"> </p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Significant experience in assessing, investigating, and auditing compliance risks.</span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"> </p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif"><b>Equivalency: </b></span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.</span></span></p> </div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Skills</H2> </div><div><p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif"><b>Required:</b></span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Demonstrated ability to handle the growing population in the L.A. Care network and audit activities.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Excellent verbal and written communication, and presentation skills.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Knowledge of relevant managed care regulations and audit methodologies.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Excellent analytical and problem-solving skills.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Ability to interface professionally with both internal and external customers at all levels of the organization.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Must be self-motivated, detail-oriented, prioritize assignments, and able to work as part of a team. </span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Knowledge of and ability to oversee the major responsibilities, accountabilities, and organization of the audit and compliance function.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Knowledge of and ability to create, implement, evaluate and enhance internal control processes.</span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint).</span></span></p> </div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Licenses/Certifications Required</H2> </div><div><div>And/Or any of the following Licenses/ Certifications:</div><div>Certified Public Accountant (CPA)</div><div>Certified Internal Auditor (CIA)</div><div>Certified Management Accountant (CMA)</div><div>Certified Fraud Examiner (CFE)</div></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Physical Requirements</H2> </div><div><div>Light</div></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Additional Information</H2> </div><div></div></div></div><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.</p> <p> </p> <p><b>L.A. Care offers a wide range of benefits including</b></p> <ul> <li>Paid Time Off (PTO)</li> <li>Tuition Reimbursement</li> <li>Retirement Plans</li> <li>Medical, Dental and Vision</li> <li>Wellness Program</li> <li>Volunteer Time Off (VTO)</li> </ul> <p> </p>