Current jobs related to Provider Data Quality Auditor II - Los Angeles, California - L.A. Care Health Plan

  • Financial Auditor Appraiser I/II/III

    4 weeks ago

    Los Angeles, California, United States County Of Shasta Full time

    ABOUT THE CURRENT VACANCYThis position is within the County of Shasta, specifically in the Department of the Assessor-Recorder. RESPONSIBILITIESAuditor Appraiser I: Under close supervision, incumbents will learn to conduct appraisals of business personal property and fixtures for tax assessment purposes. This role includes auditing and analyzing financial...

  • Quality Control Auditor

    4 weeks ago

    Los Angeles, California, United States MV Transportation Full time

    Quality Control AuditorJob LocationsUS-CA-Los AngelesIDPosition TypeRegular Full-TimeOverviewIf you reside in California, please see our California Applicant Privacy Policy for more information about our data handling practices and your data rights.ResponsibilitiesMV Transportation is seeking a Quality Control Auditor to oversee the Quality Assurance program...

  • Senior Auditor Supervisor

    4 weeks ago

    Los Angeles, California, United States California State Association of Counties Full time

    Position Overview: The California State Association of Counties is seeking applications for the role of Senior Auditor Supervisor. In this capacity, you will be responsible for planning, coordinating, and overseeing an assigned unit within a large, multifaceted division or a specialized division of the Auditor Controller's Office. Your responsibilities will...

  • Senior Auditor Supervisor

    4 weeks ago

    Los Angeles, California, United States California State Association of Counties Full time

    Position Overview: The California State Association of Counties is seeking qualified candidates for the role of Accountant Auditor Supervising. In this capacity, you will be responsible for the strategic planning, coordination, organization, and oversight of designated work units within a comprehensive, multi-faceted division or a specialized independent...

  • Healthcare Claims Quality Auditor

    3 weeks ago

    Los Angeles, California, United States MedPOINT Management Full time

    Job OverviewPosition Summary:A Healthcare Claims Quality Auditor plays a crucial role in ensuring the integrity of claims processing and adherence to regulatory standards, in alignment with the contractual commitments of Health Plans and Hospital Clients. This position involves investigating, reviewing, and liaising with provider services regarding claims...

  • Clinical Research Data Specialist II

    2 weeks ago

    Los Angeles, California, United States CEDARS-SINAI Full time

    {"h2": "Clinical Research Data Specialist II Role Overview"} Cedars-Sinai is a world-renowned academic medical center and a leader in patient care, medical research, and education. As a Clinical Research Data Specialist II, you will play a critical role in managing data for assigned research studies, designing forms for data collection, and ensuring...

  • Quality Assurance Engineer II

    4 weeks ago

    Los Angeles, California, United States First Tek Full time

    Position Overview:The Quality Systems Engineer role is essential in delivering expertise to guarantee that products are flawless and operate as intended. The QSE will be actively involved in ensuring high reliability and optimal performance according to product specifications.Key Responsibilities:- Supervise the effective execution of the Quality Management...

  • Quality Assurance Engineer II

    3 weeks ago

    Los Angeles, California, United States First Tek Full time

    Position Overview:The Quality Systems Engineer role offers a comprehensive range of expertise to guarantee that products are devoid of defects and operate as intended. The QSE will engage in ensuring high reliability and optimal performance according to product specifications.Key Responsibilities:- Supervise the effective execution of the Quality Management...

  • Quality Assurance Engineer II

    4 weeks ago

    Los Angeles, California, United States First Tek Full time

    Position Overview:The Quality Systems Engineer role encompasses a broad spectrum of expertise aimed at ensuring that products are devoid of defects and operate as intended. The QSE will engage in guaranteeing high reliability and optimal performance in accordance with product specifications.Key Responsibilities:- Supervise the effective execution of the...

  • Auditor / Financial Analyst II - Security Clearance Required

    2 weeks ago

    Los Angeles, California, United States FSA Federal Full time

    About the RoleFSA Federal is a leading provider of services to the US government, delivering high-quality support to law enforcement and homeland security agencies. We are currently seeking a skilled Auditor / Financial Analyst II to join our team and support the US Trustee Program.Key ResponsibilitiesConduct analytical and investigative work to support...

  • Senior Internal Auditor

    5 hours ago

    Los Angeles, California, United States Consultative Search Group Full time

    {"title": "Senior Internal Auditor", "content": "Job SummaryWe are seeking a highly skilled Senior Internal Auditor to join our team at Consultative Search Group. As a Senior Internal Auditor, you will be responsible for conducting operational, financial, and regulatory internal audits, identifying risks, and providing recommendations for improvement.Key...

  • Data Analyst II Position

    3 days ago

    Los Angeles, California, United States Charles R. Drew University of Med & Sc Full time

    Job Title: Data Analyst IICharles R. Drew University of Medicine and Science is seeking a highly skilled Data Analyst II to join our team. The successful candidate will provide data management functions to advising on optimal data collection and management strategies for community-engaged research and evaluation projects.Key Responsibilities:Advising on...

  • Staff Auditor

    1 week ago

    Los Angeles, California, United States Consultative Search Group Full time

    Staff AuditorA prestigious business management firm seeks a Staff Auditor to support their dynamic team in the music industry. This opportunity is ideal for an audit professional with experience in royalty compliance.Key Responsibilities:Assist in performing royalty compliance procedures for record labels and publishers on behalf of diverse clients.Support...

  • Internal Auditor

    2 weeks ago

    Los Angeles, California, United States Consultative Search Group Full time

    Job SummaryWe are seeking a highly skilled Internal Auditor to join our dynamic team at Consultative Search Group. As an Internal Auditor, you will play a critical role in ensuring the integrity and effectiveness of our internal controls and risk management processes.Key ResponsibilitiesConduct operational, financial, and regulatory internal audits to...

  • Lead Auditor-Appraiser

    4 weeks ago

    Los Angeles, California, United States Stanislaus County Full time

    POSITION SUMMARYThe Lead Auditor-Appraiser is responsible for overseeing the staff within the Business Division of the Assessor's Office. This role involves independently conducting audits and appraisals of intricate properties, along with extensive supervisory duties and responsibilities. This supervisory role may require overtime, standby, and callback...

  • Night Auditor

    1 week ago

    Los Angeles, California, United States HEI Hotels & Resorts Full time

    Job Title: Night AuditorJob Summary: We are seeking a detail-oriented Night Auditor to join our team at the Warner Center Marriott. As a Night Auditor, you will be responsible for ensuring the accuracy and integrity of our financial records, as well as providing exceptional customer service to our guests.Responsibilities:Perform daily audits of financial...

  • Clinical Research Data Specialist II

    2 weeks ago

    Los Angeles, California, United States CEDARS-SINAI Full time

    {"h2": "Clinical Research Data Specialist II Role Overview"} Cedars-Sinai is a world-renowned academic medical center and a leader in patient care, medical research, and education. Our mission is to provide high-quality, patient-centered care and to advance the field of medicine through innovative research and education. Key Responsibilities: Develop and...

  • Clinical Research Data Specialist II

    3 weeks ago

    Los Angeles, California, United States CEDARS-SINAI Full time

    Job SummaryCedars-Sinai Medical Center is seeking a highly skilled Clinical Research Data Specialist II to join our team at the Smidt Heart Institute. As a key member of our research team, you will be responsible for managing data for assigned research studies, ensuring compliance with federal and local regulations, and collaborating with bioinformatics to...

  • Clinical Research Data Specialist II

    1 day ago

    Los Angeles, California, United States Cedars-Sinai Full time

    Job SummaryCedars-Sinai Medical Center is seeking a highly skilled Clinical Research Data Specialist II to join our team in the Heart Institute. This role will be responsible for managing data for assigned research studies, including designing forms for data collection, clinical data abstraction, processing data, and producing project reports.The ideal...

  • Quality Assurance Specialist II

    3 weeks ago

    Los Angeles, California, United States Volunteers of America Los Angeles Full time

    Job OverviewAbout Us:Volunteers of AmericaEmpowering Lives Through ServiceVolunteers of America is a dedicated non-profit organization focused on providing essential human services to those in need. We strive to strengthen families and enhance community well-being through various programs, including educational initiatives, veteran support, housing...

Provider Data Quality Auditor II

4 months ago

Los Angeles, California, United States L.A. Care Health Plan Full time

Salary 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 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.

Job Summary

The Provider Data Quality Auditor II is responsible for the timely and accurate uploading of L.A. Care's provider network data, including identification and remediation of provider data errors. The Provider Data Quality Auditor must foster positive working relationships with both internal and external business partners, including L.A. Care's contracted ndependent Practice Association (IPAs), Medical Groups and Plan Partners. This position must make independent decisions to ensure data quality measures, timelines and organizational policies are met related to provider network data. The position is responsible to conduct ongoing data quality auditing of L.A. Care's provider network data, including working with their assigned provider network accounts to remediate provider data errors.

Duties

Work in a metric driven environment and is expected to understand and work in accordance with all department and company provider data metrics. Work with contracted partners to ensure timely, accurate and successful submissions of all required provider data elements via the Sender Policy Framework (SPF)/Provider Add Change Delete Workflow (PCDW) tasks by continuous provider network data quality oversight and auditing activities. Must work to identify and triage all provider data quality issues. Responsible to ensure that Senate Bill 137 requirements are met, by meeting mandated update periods for the provider's name, practice location or locations, and contact information. Responsible to manage and oversee all Data Fallout reporting as a result of SPF submissions from L.A. Care's contracted entities (IPAs, Medical Groups, Plan Partners, and Vendors). Knowledgeable of reporting formats for use in continuous data auditing, independent analysis of audit results, including root-cause analysis. Must be well-versed in written and verbal communications and is responsible for interacting with contracted partners and provide training and coaching activities to improve overall compliance with the SPF submission. (35%)

Responsible for fostering and maintaining positive working relationships with contracted partners and providing training and coaching activities to improve overall data accuracy. Must work collaboratively with Contracting and Relationship Management Account Managers to ensure that all provider data standards are met in accordance with contracts, regulations, accreditation standards, and L.A. Care Policies and Procedures, including IPA and Medical Group terminations. (15%)

Responsible to follow and execute appropriate procedures when administering provider data system overrides. Responsible to manage provider data quality issues for other L.A. Care business units, including but not limited to, Customer Solutions Center, Provider Services, Contracting and Relationship Management, and Facility Site Review. Responsible for understanding all data related contracts, regulations, accreditation standards, and L.A. Care Policies and Procedures and responsible to assist and train contracted partners about this information on an as needed basis. (20%)

Must have a strong knowledge of Provider Relations and a understanding of how Independent Practice or Physician Association (IPA) and Medical Groups operate. Manage data quality information for other L.A. Care business units, including but not limited to, Customer Solutions Center, Provider Services, Contracting and Relationship Management, and Facility Site Review. (15%)

Manage and oversee all provider data fallout, including reporting of root-cause and resolution. (5%)

Perform other duties as assigned. (10%)

Duties Continued
Education Required
High School Diploma/or High School Equivalency CertificateEducation Preferred
Associate's DegreeExperience

Required:

Minimum of at least 0-2 years of work experience in healthcare or related industry working with data.

Provider Network interaction experience.

Preferred:

Provider Relations, management or sales experience.

Policy and procedure and desktop manual development experience.

Skills

Required:

Excellent communication skills, strong analytical skills, and ability to build strong customer relationships, including the ability to work effectively with diverse team members.

Ability to perform root-cause analyses and recommend effective alternative solutions to handle Provider and Member inquiries, and to provide optimal customer service for internal and external customers.

Ability to multitask in a face-paced work environment and recommend process improvement measures for day to day operations, wherever possible.

Strong PC skills (Word, Excel, Project, etc.)

Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
LightAdditional Information

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

  • Medical, Dental and Vision
  • Wellness Program
  • Paid Sick Leave