Global Technical Talent, an Inc. 5000 Company ยท 1 day ago
SR Health Plan Auditor
Los Angeles, CA
Contract
Hybrid
Senior Level
$50.53/hr - $55.53/hr
5+ years expGlobal Technical Talent is a not-for-profit healthcare organization focused on serving vulnerable and underserved communities in Los Angeles. The Senior Health Plan Auditor is responsible for planning, executing, and reporting on financial audits and compliance for specialty health plans and vendors, ensuring adherence to regulatory requirements.
CRMHuman ResourcesInformation TechnologyStaffing Agency
Responsibilities
Performs financial audits and/or financial analyses for Specialty Health Plans
Performs financial analyses or vendor management for Client vendors
Performs claims audits for Specialty Health Plans and vendors
Provides timely and accurate deliverables to ensure financial solvency and claims processing compliance with regulatory and contractual requirements for plan partners, participating provider groups, capitated hospitals, specialty health plans, and vendors
Assists in the creation and implementation of standardized Specialty Health Plans and vendors' workpapers and reporting templates
Responsible for the documentation and maintenance of the Financial Compliance Department's policies and procedures
Responsible for the collection and completion of the quarterly and annual Department of Managed Health Care (DMHC) filing submissions
Being cross-trained on financial solvency reviews for PPGs, PPs, and capitated hospitals
Serves as primary contact and liaison for the Centers for Medicare and Medicaid Services (CMS) claim audit section of delegates
Annually reviews and updates the department's Policies and Procedures (P&Ps). Ensures that any new or updated Policy and Procedure is reviewed and approved by management prior to submission
Accountable for the completion of requests from the Legal Department, Delegation Oversight's monitoring, oversight and reporting
Serves as a subject matter expert in assigned areas and cross-training initiatives
Responsible for the overall communication and collaboration with interdepartmental personnel, leadership, specialty health plans, and vendors
Supports the design, implementation, and reporting of special projects
Supports the design and implementation of reports and tools for corrective action plan issuance and non-compliance notifications
Supports the assessment, communication, and implementation of regulatory requirements that may impact internal processes
Supports the formalization of key internal processes and monitoring tools with desktop procedures and applicable policies and procedures development
Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge
Provides training, recommends process improvements, and mentors junior-level staff, department interns, etc. as needed
Performs other duties as assigned
Qualification
Required
Bachelor's Degree in Accounting or Related Field
In lieu of degree, equivalent education and/or experience may be considered
At least 3 years of experience in conducting financial audits
At least 5 years of related experience in the managed health care industry
Minimum of 2 years of accounting experience
Strong analytical and critical thinking skills
Action-oriented, self-starter, and excellent motivator
Excellent verbal and written communication skills
Able to prioritize assignments and able to work independently with minimal supervision
Ability to interface professionally with both internal and external customers at all levels of the organization
Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint)
Must hold one of the following certifications: Certified Public Accountant (CPA), Certified Management Accountant (CMA), Certified Internal Auditor (CIA), Certified Fraud Examiner (CFE)
Benefits
Medical, Vision, and Dental Insurance Plans
401k Retirement Fund
Company
Global Technical Talent, an Inc. 5000 Company
Global Technical Talent (GTT) is a leading provider of Total Talent Solutions and a proud subsidiary of Chenega Corporation(www.chenega.com), a Native American corporation with over $1.5 billion in revenue and 7,200 U.S.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Mario Moussa
Director of Strategic Partnerships
Company data provided by crunchbase