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Customer Solution Center Audit Readiness Specialist
4 months ago
**Title:**:Customer Solution Center Audit Readiness Specialist II
**Status**: Full-Time, Hybrid
**Location:**:Los Angeles, California
**Salary**: $88,854 - $115,509
**Bonus**: 4% incentive bonus and merit increase yearly
**Sponsorship**: No visa sponsorships are supported
**_ **Position will be hybrid - during audits that are conducted in the year will come on site to collaborate with team. Must be flexible and ideally live local to Los Angeles. Person must be living in state while working remote.**_**
***
**Job Summary**:
The Customer Solution Center Audit Readiness Specialist II ensures the center is prepared for regulatory audits. They work with CSC management to create an audit strategy for key processes like enrollment, ID card distribution, and member calls. They also manage compliance efforts, including policy development and training.
This role conducts audits on member interactions to ensure compliance, providing recommendations for improvements. They handle regulatory requirements from various bodies like DHCS, DPSS, CMS, and NCQA. The specialist leads audit processes, presents findings, and ensures action plans are carried out to meet regulatory standards.
**Essential Responsibilities**:
**Audit Readiness**:
- Conducts audit procedures for Customer Solution Center departments to ensure preparedness. This includes identifying issues, setting criteria, reviewing evidence, and documenting processes and procedures.
- Conducts interviews, reviews documents, administers surveys, and prepares summaries and working papers.
- Identifies and documents audit issues and recommendations independently. Communicates results through reports and presentations to management.
- Works with business units on audit preparation and assists in document preparation for audits.
**Regulatory Compliance**:
- Collaborates with Customer Solution Center Management to assess operational effectiveness and accuracy.
- Evaluates policies and procedures against regulations and provides recommendations for improvement.
**Quality Assurance**:
- Collaborates with Business Analyst to track and analyze QA scorecard results for training and quality improvement.
- Performs additional assigned duties as needed.
**Job Qualifications**:
**Experience**:
- A minimum of 5 years experience in regulatory auditing (Appeals & Grievances, Call Center, Enrollment) in a healthcare environment required.
- Tableau experience (preferred)
**Education**:
- Bachelor's Degree in Business Administration or Healthcare Related Field
In lieu of degree, equivalent education and/or experience may be considered.
**Required Skills**:
- Advanced computer proficiency, Word, Excel; and Access is required.
- Previous experience with Medi-Cal and Medicare in a managed care environment.
- Strong analytical and team building skills.
- Ability to work effectively with diverse team members.
- Ability to formulate recommendations to improve quality and service delivery, and develop effective system and process improvements.
- Ability to multi-task and streamline day-to-day operations.
- Ability to track and trend and create regulatory reporting.
- Strong interpersonal and organization skills and is expected to work independently within the department's established guidelines, policies and procedures.
