Financial Compliance Auditor - Claims
Financial Compliance Auditor - Claims Location: LA, CA Onsite Flexibility: Onsite Contract Details:
- Position Type: Contract
Job Summary The Financial Compliance Auditor III Claims is responsible for various tasks within the Financial Compliance Unit, including the audit of claims processed by medical groups and health plans contracted with the client. This role works closely with the Supervisor and/or Lead Auditor on the identification and resolution of issues in a timely and efficient manner. For Claims Emphasis: This position is responsible for all aspects of assigned claim audits, including audit testing and completion of the audit report. This position is responsible for a variety of complex areas of the Medi-Cal, Medicare, Covered California, and PASC-SEIU 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 oversight of their Independent Practice Association (IPA) network on a quarterly & annual basis. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.
Key Responsibilities
- Perform auditing procedures under minimal supervision during the audits of medical groups and health plans.
- Provide timely and accurate reports that detail whether medical groups and health plans are meeting certain regulatory and contractual requirements.
- Communicate issues and findings that would affect the audit results.
- Perform claims audits for all medical groups and health plans contracted with L.A. Care.
- Present timely audit reports to supervisor within one week of the audit date.
- Perform analysis of medical groups and plan partners.
- Set up financial audit work papers and perform certain administrative functions for the audit team.
- Set up completely and timely work papers needed prior to going on site for the claims audits.
- Conduct sub-delegation claims oversight audit of the PPGs, capitated hospitals and the Plan Partners, including all claims processing sub-contracting functions of the delegates.
- Perform 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 related to Medi-Cal, Cal MediConnect, and/or other managed care product lines similar to L.A. Care's, L.A. Care Covered, and PASC-SEIU programs.
Required Skills
- 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.
- Flexible mode of transportation for considerable amount of travel to work off-site.
- Knowledge and understanding of legislation and regulatory bodies affecting healthcare 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, Vision, and Dental Insurance Plans
- 401k Retirement Fund
About GTT GTT is a minority-owned staffing firm and a subsidiary of Chenega Corporation, a Native 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