Financial Compliance Auditor - Claims

Primary Job Title: Financial Compliance Auditor - Claims

Location: LA, CA

Onsite Flexibility: Hybrid

Contract Details:

• Position Type: Contract
• Contract Duration: 3 months
• Start: As Soon As Possible
• Pay Rate: $50.53–$55.53 / Hour (USD)

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. 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.

Key Responsibilities:

• Claims data reporting in the Online Monitor Tool (OMT)
• Compiling the Monthly Timeliness Report (MTR)
• Completion of the financial statement analysis
• Plan Partner oversight of their Independent Practice Association (IPA) network on a quarterly and annual basis
• Acts as a Subject Matter Expert, serves as a resource and mentor for other staff
• 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 the client
• 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
• Perform certain administrative functions for the audit team
• Set up complete and timely work papers needed prior to going on-site for the claims audits
• Perform other duties as assigned
• Conducts sub-delegation claims oversight audits of the PPGs, capitated hospitals, and the Plan Partners, including all claims processing sub-contracting functions of the delegates

Education Requirements:

• Bachelor's Degree required
• Master's Degree preferred
• In lieu of a degree, equivalent education and/or experience may be considered

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 PASC-SEIU programs

Required Skills:

• Must be self-motivated
• Detail-oriented
• Able to prioritize assignments
• 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 a flexible mode of transportation for a 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

Work Environment / Physical Requirements:

• Flexible mode of transportation for a considerable amount of travel to work off-site

Benefits:

• Medical, Vision, and Dental Insurance Plans
• 401k Retirement Fund

About the Client: A not-for-profit healthcare organization focused on serving vulnerable and underserved communities in Los Angeles. Seeking entrepreneurial professionals with a passion for healthcare and business process improvement. Join our team and make a positive impact.

About GTT: GTT is a minority-owned staffing firm and a subsidiary of Chenega Corporation, a Native American-owned company in Alaska. As a Native American-owned, economically disadvantaged corporation, we highly value diverse and inclusive workplaces. Our clients are Fortune 500 banking, insurance, financial services, and technology companies, along with some of the nation's largest life sciences, biotech, utility, and retail companies across the US and Canada. We look forward to helping you land your next great career opportunity!

Job Number: 25-23364

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