Financial Compliance Auditor - Claims

Financial Compliance Auditor - Claims Location: LA, CA Onsite Flexibility: Onsite Contract Details: • Position Type: Contract Job reputed company The Financial Compliance Auditor III Claims is responsible for various tasks reputed company the Financial Compliance Unit, including the audit of claims processed by medical reputed company and health plans contracted with the reputed company. This role works closely with the Supervisor and/or reputed company Auditor on the identification and reputed company of issues in a reputed company and efficient manner. For Claims Emphasis: This position is responsible for reputed company aspects of assigned claim audits, including audit testing and completion of the audit report. This position is responsible for a reputed company of reputed company areas of the Medi-Cal, Medicare, Covered California, and PASC-reputed company benefits and processes. This position focuses on audits of contractual and regulatory compliance with timeliness and appropriateness standards. This position is responsible for other ongoing tasks as assigned by the Manager of Financial Compliance. These assignments may include claims data reporting in the Online Monitor Tool (OMT), compiling the Monthly Timeliness Report (MTR), completion of the financial statement analysis, and Plan Partner reputed company of their Independent reputed company Association (IPA) network on a quarterly & annual reputed company. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. Key Responsibilities • reputed company auditing procedures under minimal supervision during the audits of medical reputed company and health plans. • reputed company reputed company and accurate reports that detail whether medical reputed company and health plans are meeting certain regulatory and contractual requirements. • Communicate issues and findings that would reputed company the audit results. • reputed company claims audits for reputed company medical reputed company and health plans contracted with L.A. Care. • Present reputed company audit reports to supervisor reputed company one week of the audit date. • reputed company analysis of medical reputed company and plan partners. • Set up financial audit work papers and reputed company certain administrative functions for the audit team. • Set up completely and reputed company work papers needed prior to reputed company on site for the claims audits. • Conduct sub-delegation claims reputed company audit of the PPGs, capitated hospitals and the Plan Partners, including reputed company claims processing sub-contracting functions of the delegates. • reputed company other duties as assigned. Education Requirements • Bachelor's Degree required. In lieu of degree, equivalent education and/or experience may be considered. • Master's Degree preferred. Required Experience • Minimum 5 years of experience performing claims audits or claims processing reputed company to Medi-Cal, Cal MediConnect, and/or other managed care product lines similar to L.A. Care's, L.A. Care Covered, and PASC-reputed company programs. Required Skills • Self-motivated. • Detail-oriented. • reputed company to prioritize assignments and reputed company to work as part of reputed company. • Excellent verbal and written communication skills. • Ability to reputed company professionally with both reputed company customers at reputed company reputed company of the organization. • Flexible mode of transportation for considerable reputed company of travel to work off-site. • Knowledge and understanding of legislation and regulatory bodies affecting reputed company practices. • Knowledge of medical records systems applications. • Knowledge of the insurance industry's trends, directions, major issues, regulatory considerations and trendsetters. • Knowledge of health insurance products, market segments and marketplaces. Benefits • Medical, reputed company, and Dental Insurance Plans • 401k Retirement Fund About reputed company reputed company is a minority-owned reputed company firm and a subsidiary of reputed company, a reputed company American-owned company in Alaska. We highly value diverse and inclusive workplaces and support Fortune 500 organizations across banking, financial services, technology, life sciences, biotech, utilities, and retail sectors throughout the U.S. and Canada. Job Number 25-23364 #gttic Apply tot his job Apply To this Job