Financial Compliance Data Manager II
1 month ago
Salary Range: $102, Min.) - $132, Mid.) - $163, Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
The Financial Compliance Data Manager II is responsible for providing assistance and support to the Claims department to collect Medicare/ Cal MediConnect (CMC), Organization Determination, Appeals & Grievances (ODAG) data from Participating Physician Group (PPG's) and Specialty Health Plans (SHP) . The data validation template created in visual basic will need to be maintained and updated as necessary. This position will support PPG and SHP questions about the technical data collection process. This position will also support the AB1455 data upload process and reporting required by the State. This position will assist in the collection of PPG claims audit populations for audit samples purposes. This position will also support the annual CMC/ Centers for Medicare and Medicaid Services (CMS) audit by Advent/ Medicare Data Validation Audit (MDVA) to validate data integrity. (OMT) Online Monitoring Tool (OMT) by Gorman) will also be updated and reported to Regulatory Affairs and Compliance (RAC) for support of CMS regulatory reporting requirements.
DutiesOversees the updates and maintains policies and procedure for database manual, as well as provide continuous training and education to users in order to improve the processes for inputting and overall database efficiency. Trains the Medicare data analysts in the collection and follow-up with PPG's and SHP's on a regular basis. Supports PPG and SHP technical questions relating to the submission and use of the data collection template. Assists in the upload of data to Oracle as necessary. Assists in preparing reports for CMS and/or Gorman Health Group audits. Prepares custom queries and generates reports as required.
Supports the quarterly and annual AB1455 data upload process of MTR data required to be submitted to the State. Prepares and analyzes data as required.
Maintains CMC/ODAG data collection template. Modifies parameters to ensure compliance with Medicare regulatory data standards. Assists in the collection of paid claims data universes for claims audit samples. Prepares data and sample selections for the PPG Claims audits. Prepares data reports and perform analysis as requested. Maintains the Medicare data validation template. Coordinates data validation with the Claims department and Medicare Operations and assists in corrective actions plans if required. Validates data to ensure data is accurate and complete in the approved CMS format. Supports PPG and SHP technical questions relating to the submission and use of the data collection template.
Assists in the collection of MTR/CMC paid claims data for the annual MDVA/Advent audit. Reconciles and validates data integrity. Prepare reports as requested.
Maintains and updates Claims Audit automated work papers to ensure updated Medi-cal rate tables are uploaded and to ensure queries are running properly.
Populates Gorman OMT (Online Line Monitoring Tool) for Specialty Health Plans which is required by RAC for CMS requirements.
Performs other duties as assigned.
Duties ContinuedEducation Required
Bachelor's Degree in Computer ScienceIn lieu of degree, equivalent education and/or experience may be considered.Education Preferred
Master's DegreeExperience
Required:
At least 6-8 years experience in a technical function utilizing multiple software applications with Healthcare HMO experience.
Required:
Requires Information Technology (I.T.) programming skills to modify parameters and to ensure compliance with Medicare regulatory data standards.
Expert knowledge in databases and report writing.
Advanced knowledge of Visual Basic, SQL, Oracle, Access, Hyperion and Crystal reports.
Strong verbal and written communication skills as well as strong interpersonal skills.
Ability to prioritize multiple projects without compromising desired timelines.
High level of independent judgment.
Must be flexible, organized, and able to handle multiple tasks simultaneously.
Must have keen analytical skills accompanied by knowledge of the business and technology and has ability encompasses broad knowledge required from Centers for Medicare and Medicaid Services(CMS), California Department of Health Care Services (DHCS), Managed Risk Medical Insurance Board (MRMIB) and other governing body.
Licenses/Certifications RequiredLicenses/Certifications Preferred
Required Training
Physical Requirements
LightMust have SQL Programming
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
-
Claims Compliance Data Validation Analyst II
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $77, Min.) - $100, Mid.) - $123, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Claims Compliance Data Validation Analyst II
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $77, Min.) - $100, Mid.) - $123, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Financial Analyst II
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $77, Min.) - $100, Mid.) - $123, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Data Governance Program Manager II
1 month ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $121, Min.) - $140, Mid.) - $160, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Junior Data Analyst Full Time
4 weeks ago
Los Angeles, California, United States Abs Data Full timeJunior Data Analyst – Full TimeWe are looking for people passionate about data and motivated by solving problems in a dynamic, fast-paced work environment.Aventas is a fast-growing technology company, where Research Analysts have abundant opportunities for learning and career advancement.As an early member of our team, you will play a vital role in shaping...
-
Clinical Research Data Specialist II
2 weeks ago
Los Angeles, California, United States Cedars-Sinai Full timeJob DescriptionThe Smidt Heart Institute reflects Cedars-Sinai's steadfast dedication to heart disease and research innovation giving patients access to the highest level of care. Year after year, thousands of people trust their hearts to Smidt Heart Institute at Cedars-Sinai. Our cardiologists, cardiac surgeons and specialized care teams treat the full...
-
Provider Data Quality Auditor II
1 month ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $55, Min.) - $69, Mid.) - $82, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Data Engineer II
1 week ago
Los Angeles, California, United States Riot Games Full timeData Engineers at Riot bring deep knowledge of specific technical areas and also value the opportunity to work in many broader domains. Our engineers are player-focused and aim to find solutions that make players excited to experience our games. Senior Engineers, at Riot, are often called on to help with the hardest problems on a project by using their...
-
Clinical Data Analyst II
3 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $77, Min.) - $100, Mid.) - $123, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Healthcare Financial Analyst I
1 month ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $67, Min.) - $87, Mid.) - $107, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Claims Data Entry Clerk II
3 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $45, Min.) - $47, Mid.) - $55, Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure...
-
Claims Data Entry Clerk II
3 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $45, Min.) - $47, Mid.) - $55, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Senior Director II, Regulatory Operations
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $171, Min.) - $232, Mid.) - $292, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Claims Data Entry Clerk II
3 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $45, Min.) - $47, Mid.) - $55, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Research Bioinformatician II
1 month ago
Los Angeles, California, United States Cedars-Sinai Full timeJob DescriptionAs a Research Bioinformatician II, you will join the research team at the Center for Cardiac Arrest Prevention directed by Dr. Sumeet Chugh and located within the Cedars-Sinai Smidt Heart Institute. The overall goal of this Center is to predict and prevent sudden cardiac arrest, a mostly lethal condition. You will perform general...
-
Administrative Assistant II
1 day ago
Los Angeles, California, United States University of Southern California (USC) Full timeThe Division of Film and Television Production of the School of Cinematic Arts is seeking an Administrative Assistant II to provide administrative support and process budget transactions for the department. Duties will include, but are not limited to: Provides general office support including communications, event planning and reservations. Manages student...
-
Clinical Research Associate II
3 weeks ago
Los Angeles, California, United States Cedars-Sinai Full timeJob DescriptionWe invite you to consider this great opportunityWhen the work you do every single day has a crucial impact on the lives of others, every effort, every detail, and every second matters. This shared culture of happiness, passion, and dedication pulses through Cedars-Sinai.Dr. Omar Al-Louzi, MD is seeking a highly motivated Clinical Research...
-
Financial Analyst Client and Matter Management
4 weeks ago
Los Angeles, California, United States Consultative Search Group Full timeA global law firm consistently ranked among the top firms in the world, is seeking a Financial Analyst - Client & Matter Management to join our dynamic team in Global Services Office in downtown Los Angeles. Please note that this role may be eligible for a flexible working schedule that allows for a hybrid and in-office presence. About the roleAs a...
-
Administrative Assistant II
1 day ago
Los Angeles, California, United States University of Southern California (USC) Full timeThe mission of the USC Suzanne Dworak-Peck School of Social Work is to improve the well-being of vulnerable individuals and communities, advance social and economic justice, and eradicate pressing societal problems in complex and culturally diverse urban environments throughout Southern California, the nation, and the world. Our mission is achieved by...
-
finance manager
4 weeks ago
Los Angeles, California, United States SBH Fashion Full timeItalian luxury fashion brand lifestyle collection known for modern femininity and sophistication is hiring a Finance Manager based out of Los AngelesKey Accountabilities:Financial Planning and Analysis:Develop and maintain financial models to forecast company performance and financial health.Analyze financial data and provide insights to support strategic...
