Financial Compliance Auditor III Finance

Job Summary

The Financial Compliance Auditor III Finance is responsible for various tasks within the Financial Compliance Unit, including audit of the financial statements and audit of claims processed by medical groups and health plans contracted with L.A. Care. This role works closely with the Supervisor and/or Lead Auditor on identification and resolution of issues in a timely and efficient manner. This position leads assigned audits 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. This position is responsible for all aspects of the assigned audits including audit testing, financial solvency ratios analysis and completion of the audit report. This position includes assessment of cash, accounts receivable, risk pool receivable, current assets, accounts payable, IBNR reserves and current liabilities. This position is responsible for a variety of complex areas of the Medi-Cal, Covered California, Cal MediConnect, Healthy Kids, and PASC-SEIU benefit and process.

Duties

Responsible for ongoing tasks that includes but not limited to claims data reporting in the Online Monitor Tool (OMT), compiling Monthly Timeliness Report (MTR), completion of the financial statement analysis, and Plan Partner oversight of their IPA network on a quarterly & annual basis. Performs auditing procedures under minimal supervision during the financial audits of medical groups and health plans. Provides timely and accurate reports that detail whether medical groups and health plans are meeting certain regulatory and contractual requirements. Communicates issues and findings that would affect the audit results.

Performs audits for all medical groups and health plans contracted with L.A. Care. Timely audits reports presented to supervisor with one week of the audit date. Communicates issues and findings that would affect the audit results.

Performs analysis of medical groups and plan partners. Prepares quarterly reports that analyze compliance with certain financial ratios.

Sets up financial audit work papers. Performs certain administrative functions for the audit team. Sets up completely and timely work papers needed prior to going on site for the claims audits.

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.

Performs other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:
At least 5 years of experience performing financial audits with the demonstrated experience on the following list of stated knowledge/experience:

Skills

Required:
Must be self-motivated.

Detail-oriented.

Able to prioritize assignments, and able to work as part of a team.

Excellent verbal and written communication skills.

Ability to interface professionally with both internal and external customers at all levels of the organization.

Must also have flexible mode of transportation for considerable amount of travel to work off-site.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information