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<p><b>Salary Range:&nbsp;&nbsp;<b><b><b><b>$47,840.00</b></b></b></b>&nbsp;(Min.) -&nbsp;<b><b><b><b>$57,062.00</b></b></b></b>&nbsp;(Mid.) -&nbsp;<b><b><b><b>$68,474.00</b></b></b></b>&nbsp;(Max.)</b></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><h4>Job Summary</h4><p>The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the authorization process including intake, logging, tracking and status follow-up.</p><p>The Authorization Technician II collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory time lines by maintaining an accurate database inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance/appeal requests, and prepares UM Activity and Weekly Compliance Reports.</p><p>In addition, the position performs data entry and processing of referrals/authorizations in the system, &nbsp;authorizes request consistent with auto authorization criteria, maintains confidentiality when communicating member information, and assists with the communication of determinations by preparing template letters for members/ providers, with other duties as assigned.</p><h4>Duties</h4><h4>Functional Elements: Technical Support to UM Specialist: Processing of time sensitive authorization and pre-certification requests to meet department timeframes and regulatory requirements; Computer Input: Accurately and completely processing referrals/authorizations and distribute a complete file to UM Specialist within 2 hours of receipt; identify duplicate requests using the claims and verify existing authorization. Independently identifying and appropriately returning to claims or member services any file that is a duplicate to one already processed in the system; appropriately documenting what information was used in making this determination within 4 hours of receipt. Appropriate identification and timely notification of time sensitive requests; appropriately identifying for the staff which you support, request that are priority based on date of receipt and established Turnaround Time criteria for compliance. Accurate filing/maintenance of confidential member information. Creating secure, complete, files. Interface with members, medical personnel and other internal and external agencies; ensure&nbsp; all comply with L.A. Care requirements such as submitting requested information in a timely manner and using the approved Authorization Request form with complete medical information i.e.: ICD 10 codes, CPT, HCPC codes. (35%)</h4><h4>Assist in the preparation of communication for authorization determinations, including, but not limited to preparing template letters for members and providers (authorization approval, denial, deferral, modification and pay/education). (30%)</h4><h4>Assist in the technical aspects of the retrospective review process for authorizations and Member or Provider Appeals, including, but not limited to computer data entry, logging, copying, preparing of template letters for communication of appeal determinations to members, providers and partners (appeal uphold or overturn) and filing: Set up GNA files for review, log and keep track all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters to Grievances Specialist on daily basis. (20%)</h4><h4>Support UM Committee and Audit activity via Department performance reporting. Assure the accuracy of reports concerning inventory and department proficiency in maintaining regulatory standards and time frames. (5%)</h4><p>Perform other duties as assigned. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4><h4>Experience</h4><p><b>Required:</b></p><p>At least 6 months of health care experience.</p><p>Experience working in a cross functional work environment.</p><p><b>Preferred:</b></p><p>Experience in Medi-Cal managed care.</p><p>1 year of experience in UM/Prior Authorization.</p><h4>Skills</h4><p><b>Required:</b></p><p>Demonstrated proficiency in Medical Terminology required.</p><p>Strong verbal and written office communication skills.</p><p>Proficient with Microsoft Office Suite and Adobe PDF. and </p><p>Excellent organizational, interpersonal and time management skills. </p><p>Must be detail-oriented and an enthusiastic team player.</p><p><b>Preferred:</b></p><p>Knowledge of QNXT computer systems a plus.</p><p>Knowledge of the UM patient referral process.</p><p>Knowledge of member’s health plan eligibility.</p><p>Knowledge of member’s benefits coverage. </p><p>Knowledge of Health Plan regulations.</p><p>Knowledge of HMO/UM functions.</p><p>Knowledge of ICD-10/CPT coding. </p><p>Proficient utilizing electronic medical records and documentation programs.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Medical Coding Certification<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Required:</b></p><p>Weekends and holidays hours may be required, as well as OT based on a business need.</p><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>This position is a limited duration position. The term of this position is a minimum one year and maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits.</p><p><br><b>L.A. Care offers&nbsp;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><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    EMR, Data Entry, Medical Coding, Claims, Healthcare, Administrative, Insurance                                                    </p>

L.A. Care Health Plan

Authorization Technician II (12 Month Assignment)

<p><b>Salary Range:&nbsp;&nbsp;<b><b><b><b>$46,800.00</b></b></b></b>&nbsp;(Min.) -&nbsp;<b><b><b><b>$52,597.00</b></b></b></b>&nbsp;(Mid.) -&nbsp;<b><b><b><b>$62,270.00</b></b></b></b>&nbsp;(Max.)</b></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><h4>Job Summary</h4><p>The Quality and Population Health Coordinator I (QPHC) is responsible for outreaching to members to close care gaps. The QPHC also outreaches to providers for medical record pursuit and retrieval.&nbsp; This position supports the L.A. Care medical groups by assisting with scheduling member appointments. While this role is a combination of remote and in office work, this role is intended to support L.A. Care medical groups by being embedded in the provider offices and providing direct outreach to L.A. Care members. The QPHC is an important member of L.A. Care’s quality improvement team, helping to drive improvement in health outcomes, population health, and health equity, as well as member and provider experience.</p><h4>Duties</h4><h4>Make outbound calls to members to assist with scheduling and coordinating services (e.g. appointments, lab tests, health screenings, other diagnostic studies, transportation, etc.). (25%)</h4><h4>Educate members on missing gaps in care. Encourage them to close care gaps and pursue preventative health and health promotion activities such as health fairs. (25%) </h4><h4>Outreach to providers to request medical reports by fax, electronic medical records, or on-site visits if needed. (15%) </h4><h4>Review medical records, claims, and encounter data to identify key information to help close gaps in care. (15%)</h4><h4>Provide support as needed for care gap closure campaigns and other quality improvement programs. (15%)</h4><p>Perform other duties as assigned. (5%)</p><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4>Associate's Degree<h4>Experience</h4><p><b>Required:</b></p><p>At least 3 months of experience following basic workflows, procedures, and standards related to patient or provider communication and outreach.</p><p>Previous experience working in an office setting with basic office equipment such as telephones, fax machines, computers, etc.</p><p><b>Preferred:</b></p><p>Health Plan, provider practice, or health education experience. </p><h4>Skills</h4><p><b>Required:</b></p><p>Demonstrates deep compassion and sensitivity towards patient needs and community well-being. </p><p>Driven by strong motivation to positively impact people’s lives.</p><p>Excellent verbal and written communication skills.</p><p>Excellent interpersonal skills.</p><p>Proficient with Microsoft Word, Excel, PowerPoint, and Outlook.</p><p>Skills in utilizing various online platforms and search engines to efficiently gather accurate and relevant information. </p><p>Highly organized with ability to maintain accurate notes and records.</p><p>Demonstrates high efficiency in managing tasks and consistently delivering projects to successful and reliable completion. </p><p>Ability to communicate effectively with patients and health care providers. </p><p><b>Preferred:</b></p><p>Some knowledge of HEDIS and other quality measures.</p><p>Some knowledge of quality improvement processes.</p><p>Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese&nbsp;&nbsp; </p><h4>Licenses/Certifications Required</h4>Active &amp; Current Driver's License, with a clean record and Auto Insurance Required<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Required:</b></p><p>Travel to offsite locations for work.</p><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>This position is a limited duration position. The term of this position is a minimum one year and maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits.</p><p><br><b>L.A. Care offers&nbsp;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><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    EMR, Claims, Medical, Equity, Healthcare, Insurance, Finance                                                    </p>

Quality and Population Health Coordinator I (ALD)

<p><b>Salary Range:&nbsp;</b>&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</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><h4>Job Summary</h4><p><br>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 (i.e. Enrollment processing timeliness and accuracy of loading members, timeliness of I.D. Card and member materials, outbound health risk assessment (HRA) calls for Seniors and People with Disabilities (SPD) and Cal MediConnect (CMC) plus HIF for L.A. Care Medi-Cal Direct program (MCLA), call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This position is responsible for the ongoing progression and maintenance of CSC's compliance program efforts, including, but not limited to, policy and procedure development, training and education initiatives, and compliance programmatic developments and enhancements.</p><p>This position will complete targeted, focused and random audits related to member interactions and outcomes to ensure all elements are compliant. These results will be provided to management with recommendations and/or corrective actions required to remediate the deficiencies. This position will be responsible for the regulatory obligations for each line of business and their governing bodies; California Department of Health Care Services (DHCS), Department of Public Social Services (DPSS), Centers for Medicare and Medicaid Services(CMS), LACC - CalHers, and National Committee for Quality Assurance (NCQA) along with review and analysis of regulatory requirements for all product lines The position will take lead in all of the audit situations and be prepared to present and report full findings and ensure action plans are created, executed, and verified through reconciliation of end to end on all regulatory functions. &nbsp;&nbsp;</p><h4>Duties</h4><p>Audit readiness: Performs audit procedures for Customer Solution Center departments to ensure readiness; including identifying and defining issues, developing criteria, reviewing and analyzing evidence, and documenting business unit processes and procedures. Conducts interviews, reviews documents, develops and administers surveys, composes summary memos and prepares working papers. Identifies, develops, and documents audit issues and recommendations using independent judgement concerning areas being reviewed. Communicates or assists in communicating the results of audit and consulting projects via written reports and oral presentations to Customer Solution Center management. Collaborates with business units in audit universe preparation and validation. Assists in document preparation for regulatory and internal audits.<br><br>Regulatory compliance: Works closely with Customer Solution Center Management to determine and handle effectiveness/accuracy of operational processes. Collaborates with internal Subject Matter Experts (SMEs) to understand Customer Solution Center regulatory processes and assists with getting to the root cause of identified deficiencies. Evaluates policies and procedures with applicable regulations/guidelines and provides recommendations to management for continuous process improvements. &nbsp; &nbsp; &nbsp; &nbsp;</p><p>Collaborates with Customer Solution Center Business Analyst to track, trend, and analyze results of Quality Assurance (QA) scorecards for training and quality improvement. &nbsp;</p><p>Perform other duties as assigned.&nbsp;</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p><b>Required:</b></p><p>A minimum of 5 years of experience in regulatory auditing (Appeals &amp; Grievances, Call Center, Enrollment) in a healthcare environment required. </p><p>Previous experience with Medi-Cal and Medicare in a managed care environment. </p><p><b>Preferred:&nbsp; </b></p><p>Tableau experience.</p><h4>Skills</h4><p><b>Required:</b><br>Advanced computer proficiency, Word, Excel; and Access is required.&nbsp;</p><p>Strong analytical and team building skills.&nbsp;</p><p>Ability to work effectively with diverse team members.&nbsp;</p><p>Ability to formulate recommendations to improve quality and service delivery, and develop effective system and process improvements.&nbsp;</p><p>Ability to multi-task and streamline day-to-day operations.&nbsp;</p><p>Ability to track and trend and create regulatory reporting.</p><p>Strong interpersonal and organization skills and is expected to work independently within the department's established guidelines, policies and procedures.&nbsp;</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call.</p><p>This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned</p><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;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><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Medicare, Social Services, Medicaid, Call Center, Audit, Healthcare, Service, Customer Service, Finance                                                    </p>

Customer Solution Center Audit Readiness Specialist II

<p><b>Salary Range:&nbsp;</b>&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</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><h4>Job Summary</h4><p>The Enhanced Care Management (ECM) Clinical Specialist II is responsible for the management and oversight activities associated with L.A. Care's ECM network.&nbsp; The position reports to the Supervisor of ECM and receives clinical supervision as needed from the Medical Director of Care Management. The position is responsible for providing oversight, feedback, and technical assistance to ECM Providers to support effective delivery of ECM services and ensure compliance with local, State, and Federal regulations, statues and guidelines. The position is responsible for conducting regular meetings with providers, reviewing Assessments &amp; Care Plans, providing guidance on clinical best practices, and assisting with escalation of cases that require additional assistance from L.A. Care. The position works directly with Care Management and Provider Network Management staff to inform Provider capacity-building and training activities related to the ECM Program operations.</p><h4>Duties</h4><p>Conduct regular monitoring and coaching with Providers to review aggregate progress and individual ECM member cases. May use telephonic, onsite, or written methods and both group and individual Provider activities to monitor performance related to Provider clinical and service requirements. Provide guidance on best practices to ECM providers.</p><p>Conduct a monthly random sample review of Assessments and Care Plans created by the ECM Provider. Identify any gaps in the Care Plan services or regulatory compliance and provide coaching and feedback to the Provider to improve.&nbsp; Identify any issues that require escalation or more frequent monitoring of the ECM Provider. Organize and perform file review process in accordance with given criteria to include collection &amp; verification of supporting documentation, recording received information in appropriate tracking systems, and communicating end results of requests in writing and/or verbally. </p><p>Provide training, education and consultation as necessary to Providers. Collaborate with other ECM staff on identifying topics and developing materials for Provider training and capacity building. </p><p>Assist ECM Providers with escalation of ECM member cases that require additional assistance from L.A. Care. </p><p>Assist ECM Providers with the coordination of member care with internal L.A. Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and Support (MLTSS), Social Services, Behavioral Health, Community Health, Health Education, as well as external providers such as Participating Physician Groups (PPGs) and Primary Care Physicians (PCPs). </p><p>Actively identifies and implements efforts to improve the quality, effectiveness and efficiency of ECM.&nbsp; Assist co-workers with special projects or work volume as required. Communicates any barriers to supervisors in an efficient and effective manner. </p><h4>Perform other duties as assigned.</h4><h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree in NursingMaster's Degree in Social Work for Licensed Clinical Social Workers<h4>Education Preferred</h4>Bachelor's Degree in Nursing<h4>Experience</h4><p><b>Required:</b></p><p>Minimum 3 years of&nbsp; recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments.&nbsp; </p><p>Previous care management experience to include auditing/oversight/performance management experience.</p><h4>Skills</h4><p><b>Required:</b></p><p>Current knowledge of clinical standards of care and disease processes, and community resources.</p><p>Excellent verbal and written communicating skills; excellent interpersonal skills. </p><p>Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine the most effective member-centered interventions.</p><p>Proficiency in Microsoft Office MS Office applications. </p><p>Maintain confidentiality in compliance with all Health Insurance Portability and Accountability Act (HIPAA) requirements. </p><p>Ability to solve complex issues and identify creative solutions with external agencies.&nbsp; </p><p>Excellent project management skills.</p><p>Working knowledge of Medi-Cal and Medicare regulations.</p><p><b>Preferred:</b></p><p>"Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese".</p><h4>Licenses/Certifications Required</h4>Licensed Clinical Social Worker (LCSW); Current and unrestricted California License or Registered Nurse (RN); current and unrestrited California License.<h4>Licenses/Certifications Preferred</h4>Certified Professional in Utilization Review (CPUR)Certified Case Manager (CCM)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><strong>Preferred:&nbsp;</strong><br>Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), Utilization Management or Compliance</p><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;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><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Social Worker, Nursing, Registered Nurse, Behavioral Health, Clinic, Service, Healthcare                                                    </p>

Enhanced Care Management Clinical Specialist II

<p><b>Salary Range:&nbsp;</b>&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</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><h4>Job Summary</h4><p><br>The Internal Auditor III prepares audit programs and conducts audit reviews of assigned areas, including performing various audit procedures and documents in findings in work papers in accordance with department standards. Identifies internal control weaknesses, develops audit recommendations and drafts written reports. Provides independent evaluations of operational and financial controls, policies, and procedures. Prepares audit report detailing findings and recommendations. Performs and coordinates follow-up audits to determine if management has taken action to mitigate risks identified. Participates in special reviews as necessary.Acts as a &nbsp;Subject Matter Expert, serves as a resource and mentor for other staff.&nbsp;</p><h4>Duties</h4><p>Develops audit programs and testing procedures relevant to risk and test objectives. Provides independent evaluations of operational and financial controls, regulatory compliance, policies, and procedures. Prepares work papers, observations and reports and related documents following department standards.</p><p>Prepares audit programs and conducts audit reviews of assigned areas, including performing various audit procedures and documenting findings on work papers. Obtains and reviews evidence ensuring audit conclusions are well-documented. </p><p>Identifies internal control weaknesses, non-adherence with regulatory requirements, develops audit recommendations and drafts written reports. Identifies and communicates issues raised, offering recommended solutions relevant to business and risk. Ensures audit conclusions are based on a complete understanding of the process, circumstances, and risk. </p><p>Performs and coordinates follow-up audits to determine if management has taken action to mitigate risks and findings identified.</p><p>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.</p><p>Participates in special reviews as necessary.</p><p>Performs other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Accounting or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p><strong>Required:</strong><br>At least 5 years of public or private accounting or audit experience, preferably in health care or other highly regulated industry.</p><h4>Skills</h4><p><br><b>Required:</b><br>Knowledge of finance, accounting and control principles, including GAAP and GAAS.</p><p>Excellent MS Office skills, including in Word, Excel and PowerPoint.</p><p>Ability to observe and understand business processes ensuring processes are documented completely and accurately.</p><p>Ability to apply audit standards through practical application.</p><p>Proactive in researching business best practice concepts in order to apply as appropriate.</p><p>Solid listening skills and ability to identify gaps in logic – inquisitive.</p><p>Strong organization and follow up skills including the ability to handle competing priorities and meet all deadlines and commitments.</p><p>Possess an appropriate combination of technical expertise in fields such as auditing, finance, technology, operations, or investigations.</p><p>Ability to flourish in a fast-paced, complex environment and willing to adapt to change.</p><p>Ability to give and follow instructions accurately and efficiently; proactive in asking clarifying questions to ensure work effort is directed wholly toward desired outcome.</p><p>Ability to recognize when learned theoretical concepts should be applied.</p><p>Solid understanding and ability to apply risk and control concepts</p><p>Ability to identify underlying cause of an issue raised.</p><p>Good awareness of other departments in the company with risk, control, and governance responsibilities and what is necessary for successful tactical collaboration and information sharing.</p><p>Good communication skills along with good or developing negotiation skills.</p><p>Ability to identify sensitive issues and facilitate communications in a proactive manner to avoid surprises.</p><p>Willingness and ability to adapt to new circumstances, information, and challenges.</p><p>Executes effective and thorough application of all internal audit standards within assigned responsibility.</p><p><b>Preferred:</b><br>Knowledge of Sarbanes-Oxley and COSO guidelines and requirements.</p><p>Risk assessment practices.</p><h4>Licenses/Certifications Required</h4>Certified Public Account (CPA) or Certified Internal Auditor (CIA) or Cerfitified Fraud Examiner (CFE) or Certified Information Systems Auditor (CISA)<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;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><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Internal Audit, Risk Management, Accounting, CPA, Audit, Finance                                                    </p>

Internal Auditor III

<p><b>Salary Range:&nbsp;</b>&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</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><h4>Job Summary</h4><p>The Enterprise Risk Adjustment Analyst III provides a key leadership role in the Risk Adjustment Department by independently determining and recommending the source/type of data to be used, design/method in which to create reports or conduct analysis to address business objectives, and recommendations for course of action.&nbsp; </p><p>This position works in collaboration with the Enterprise Risk Adjustment department leadership and provides leadership/guidance in matters related to data processing, data storage, and data architecture. The position provides guidance and direction to the analyst, internal and external stakeholders with regards to reporting and analytics.</p><p>Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Serves as Subject Matter Expert (SME) for the data processing, reporting, and analytics required to support the Risk Adjustment department operations Chief Architect for reporting and analytics in support of Risk Adjustment operations for multiple lines of businesses. Serves as key contact for both internal (L.A. Care) and external (Vendors, regulatory agencies, etc.) requestors for Risk Adjustment data and reporting. Works with the risk adjustment vendors and keeps up to date on the latest risk adjustment changes that regulatory bodies pass on to health plans as it relates to reimbursement reporting requirements. Brings identified concerns to the Manager with recommendations for resolution.</p><p>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.</p><p>Creates and produces summary reporting artifacts to give the Risk Adjustment Department the ability to monitor its performance. Provides guidance and direction to the analyst, internal and external stakeholders with regards to reporting and analytics. Conducts and provides analytical insight to gaps in performance.&nbsp; </p><p>Continuously monitors and reviews the daily operations to identify areas of improvement and for automation process. Designs and creates processes for data extraction, summaries, and higher level analytic functions to create and use on data queries and stored procedures. Creates and maintains database for the Risk Adjustment team to improve the workflow in various operational areas of risk adjustment.</p><p>Understands the end to end requirements for XML and 837 data processing channels to provide impact analyses from regulatory changes to these processes, and data reconciliation gaps.</p><p>Performs other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p><strong>Required:</strong><br>At least 5 years of experience working in a risk adjustment role with increasing responsibilities and working with data submitted to regulatory agencies, and the return reports received from same.</p><h4>Skills</h4><p><b>Required:</b><br>Ability to consult with senior management help define business objectives and recommend analysis approach to address these objectives.</p><p>Ability to provide expertise on analytic, programmatic, and process changes that is a response to changing business needs.</p><p>Ability to query from various internal databases and external vendors systems in order to write/build/develop needed data to perform higher level of analytics to address business objectives. Provide recommendations to senior leadership based on analytics outcome.</p><p>Knowledge of risk adjustment processes for multiple lines of business.</p><p>Reporting and analytics experience of SQL Server, Visual Studio 2012, Oracle, Microsoft Access and Excel.</p><p>Knowledge of MS Word, Adobe Reader, PowerPoint programs.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;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><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Risk Management, Finance                                                    </p>

26 L.A. Care Health Plan Jobs