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Regulatory Audits and Governance Compliance Advisor III (Temporary with Benefits)Job Category:Administrative, HR, Business ProfessionalsDepartment:ComplianceLocation:Los Angeles, CA, US, 90017Position Type:Full TimeRequisition ID:5286Established 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, we make sure our members get the right care at the right place at the right time.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.Job SummaryThe Regulatory Audits and Governance Compliance Advisor III ensures that all external regulatory agency audits (including CMS, state of California audits) are managed in accordance with Compliance Department policies and guidance from all applicable regulatory agencies. This position will oversee the correction of regulatory audit findings, validate the implementation of corrective action plans, and provide ongoing monitoring for all regulatory audit areas. This position will lead activities aimed at improving organizational audit readiness and performance. This position will develop all regulatory reports, agendas, minutes and communications to the Internal Compliance Committee and the Compliance Department component of the Quality and Compliance Committee of the Board of Directors. DutiesManages all regulatory audits for the organization including but not limited to program, medical, data validation, financial. Ensures timely, accurate, and complete submission of responses to regulatory auditors. Develop, maintain, and report periodic status reports to Leadership Team and stakeholders pursuant to activities. Designs and conducts audit readiness assessments to determine gaps in compliance, determine opportunities for remediation and process improvement, and guide in implementation of the corrective actions. Leads and facilitates cross-functional work group meetings involving leadership and to ensure audit readiness. Proactively works with management team to improve organizational effectiveness on regulatory audits.Conducts ongoing monitoring through development of compliance key performance indicators (KPIs). Drives remediation efforts and provides internal and external stakeholders with recommendations to improve compliance in their areas. Manages the Internal Compliance Committee materials and the Compliance Department component of the Compliance and Quality Committee of the Board of Directors. Design and deploy regulatory audit training for both internal and external stakeholders. Perform other duties as assigned.Education RequiredBachelor's Degree in Business Administration or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.Education PreferredJuris Doctor Degree or Doctor of Law Degree (J.D.)ExperienceRequired:
At least 5 years of auditing experience (preferably in Appeals, Credentialing, Grievances, Quality Improvement, UM, and so forth) and developing audit tools in a managed care setting.Experienced in auditing or comparable managed healthcare product development or product management (preferably in Appeals, Credentialing, Grievances, Quality Improvement, UM, and so forth or Medicare Advantage/Cal MediConnect/MediCal product management experience) and /or development of audit tools in a managed care setting. Working knowledge of Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Centers for Medicare and Medicaid Services(CMS) and National Committee for Quality Assurance (NCQA) requirements is required Preferred:
Supervisory experience. Two or more years of Internal auditing experience for a health plan or healthcare system.Work experience in health plan, physician group, or hospital administration.At least 3 years of experience overseeing external regulatory audits.SkillsRequired:
Must possess a strong understanding of Medi-Cal and Medicare laws and regulations and other state programs.Highly developed analytical and critical thinking skills.Excellent written and oral communication skills are essential. Ability to manage multiple priorities and projects and meet deadlines. Demonstrated delivering training programs and making presentations to staff and providers.Licenses/Certifications RequiredLicenses/Certifications PreferredCertified HealthCare Compliance (CHC)Required TrainingAdditional InformationL.A. Care offers a wide range of benefits including
Medical, Dental and Vision
Wellness Program
Paid Sick Leave
