Financial Compliance Auditor

3 weeks ago

Rancho Cucamonga, United States Inland Empire Health Plan Full time
What you can expect

Find joy in serving others with IEHP We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience

Under the direction of the IPA Financial Compliance Manager, the Financial Compliance Auditor is responsible for conducting financial monitoring and oversight of IEHP’s delegated entities’ financial compliance. This will include performing audits, identifying risks, reporting the results, and working with the IPAs to ensure they develop and implement an effective corrective action plan (CAP), in addition to, collaboration with inter-departments to ensure member needs are met while simultaneously building strong peer relationships.

Major Functions (Duties and Responsibilities)

1. Perform financial audits of contracted IPAs, medical groups, and/or delegated entities to verify solvency and good financial standing.
2. Conduct exit interviews with delegated Providers to provide a preliminary overview of the audit results and to inform them of the next steps in the audit process.
3. Draft financial audit reports of contracted IPAs, medical groups, and/or delegated entities summarizing audit results, findings, and/or required corrective action plans (CAPs).
4. Follow-up and assist Providers with corrective action plans (CAPs) as needed to ensure compliance.
5. Collaborate with the Claims Oversight Delegated team to share information from the financial audits and coordinate audit timing.
6. Prepare quarterly financial viability reporting for all IPAs, medical groups, and/or delegated entities for the Delegation Oversight Committee.
7. Monitor delegated entities’ compliance with maintaining sufficient and active LOCs when required by contract terms.
8. Collaborate with IPAs to implement the Department of Health Care Services (DHCS) Medical Loss Ratio (MLR) reporting requirements.
9. Participate in the data collection for the Rate Development Template (RDT).
10. Promote teamwork and maintain effective working relationships with others throughout the organization.
11. Demonstrate a commitment to incorporate LEAN principles into daily work.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

Competitive salary.
Hybrid schedule.
CalPERS retirement.
State of the art fitness center on-site.
Medical Insurance with Dental and Vision.
Life, short-term, and long-term disability options
Career advancement opportunities and professional development.
Wellness programs that promote a healthy work-life balance.
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance

Education & Experience

Minimum of two (2) years of experience in healthcare accounting/financial auditing.
Bachelor’s degree in Accounting, Finance or related field from an accredited institution required.

Key Qualifications

Knowledge of Generally Accepted Accounting Principles and Financial Audit Principles.
Solid understanding of DMHC, DHCS and CMS rules and regulations governing financial compliance.

Start your journey towards a thriving future with IEHP and apply TODAY

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