About this role
<p><b>Salary Range: </b> $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (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><span style="font-size:10.0pt"><span style="font-family:'Calibri', sans-serif">The Delegation Oversight Compliance Auditor III is responsible for planning, coordination, and conducting comprehensive compliance audits and reviews to assess adherence to regulatory requirements, contractual obligations, and internal policies for L.A. Care subcontracted providers. Additionally, the Auditor III will provide updates and recommendations to Management on quality and delegation oversight responsibilities, participate in fraud, waste, and abuse investigations as applicable, and oversee pre-delegation and annual audits for new and existing delegated entities to drive continuous improvement and adherence to regulatory standards by ensuring delegates are compliant with regulatory requirements. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.</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 style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Applies subject expertise in evaluating business operations and processes. 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 project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif"><b>Regulatory:</b></span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Researches, analyzes, and interprets contractual, state, and federal regulatory, and accreditation requirements. Stays abreast of changes in healthcare regulations, laws, and industry standards; analyzes regulatory developments and assesses their impact on the organization. Updates existing audit tools and creates audit tools based on the regulatory requirements. Assists management team with informing team of regulatory changes to ensure alignment with regulatory requirements and industry best practices.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif"><b>Audit:</b></span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Plans, coordinates, and conduct with other auditors and conducts comprehensive compliance audits and reviews to assess adherence to regulatory requirements, contractual obligations, and internal policies for L.A. Care subcontracted providers including, but not limited to, Participating Physician Groups, Plan Partners, and Specialty Health Plans/Vendors. Independently conducts complex audits, including scoping, research, tool development, field work, reporting, and corrective action plan validation. Identifies, documents, and trends audit issues and provides appropriate coaching and shares best practices with delegated entities to assist with performance improvement. </span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif"><b>Investigate and Risk Assessment:</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">Investigates and escalates allegations of non-compliance, fraud, or misconduct; develops and implements corrective action plans to address identified issues and prevent recurrence. Conducts risk assessments to identify compliance risks and develops strategies to mitigate risks and strengthens internal controls. Alerts management of identified new or emerging compliance risks and makes recommendations on DOA’s audit plan or monitoring plan to other business unit. Serves as a subject matter expert in compliance auditing, risk assessment, risk mitigation planning and regulatory interpretation and application. </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 style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif"><b>Collaboration:</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">Leads entrance calls, exit conferences, and technical calls with delegates. Collaborates with cross-functional teams, including but not limited to Legal, Compliance, Quality Assurance to address compliance-related challenges and delegate’s performance deficiencies, and implement effective solutions. Assists management to establish processes to track program effectiveness; monitor and analyze data to identify trends and areas for improvement. Works closely with Delegation Oversight Audit management on and to co-lead projects.</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>Reports:</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">Prepares and presents comprehensive reports and presentations to senior leadership, internal Committees, external entities, summarizing compliance activities, findings, and recommendations. Reviews and provides feedback on work papers of other Auditors to ensure accurate testing, results, and reports, and to ensure adherence to departmental procedures and protocols.</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>Training:</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">Develops and delivers compliance training programs for internal staff members, such as Delegation Oversight Audit team, and other business units within L.A. Care. In addition, to develop training programs for delegates as external entities ensuring awareness of compliance requirements and promoting a culture of compliance throughout the organization and with delegates. Leads and manages compliance projects and initiatives, auditors’ trainings. Develops training materials, updates audit tools, performs risk assessments, policy development, and process improvement efforts. </span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"> </p> <p><span style="font-size:10.0pt"><span style="font-family:'Calibri', sans-serif">Perform 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 Healthcare Administration 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></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><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">At least 4 years of audit experience in compliance, delegation oversight, or audit within the healthcare industry.</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">Demonstrated experience developing and delivering training programs and making presentations to internal staff and providers.</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">Experience in health care service plans with significant delegation arrangements. </span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"> </p> <p><span style="font-size:10.0pt"><span style="font-family:'Calibri', sans-serif">Experience working with Policies and Procedures.</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 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">Ability to manage multiple priorities, projects and meet deadlines.</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">Superior written and verbal communication skills.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif"> Ability to draft policies and procedures. </span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Exceptional analytical and problem-solving skills, with a meticulous attention to detail.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Strong communication and collaboration abilities, with the capacity to engage effectively with stakeholders at all levels.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Ability to create a work environment that fosters team building and encourages a collaborative approach to achieving departmental and organizational goals.</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">Proficient in Microsoft Office, Excel, and PowerPoint.</span></span></p> <p><span style="font-size:10.0pt"><span style="font-family:'Calibri', sans-serif">In-depth knowledge of federal and state laws, Medicaid regulations, and healthcare compliance standards.</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></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 Preferred</H2> </div><div><div>Certified HealthCare Compliance (CHC)</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">Required Training</H2> </div><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>