Solugenix
Overview
Senior Health Plan Auditor. 3-Month Contract (Possibility of Conversion) based out of Los Angeles, CA (Hybrid). Solugenix is assisting a client, a health insurance company, in this search. Base pay range: $55.00/hr - $57.00/hr. This role is part of a team responsible for planning, execution, reporting, and corrective action plan monitoring of financial solvency and claims processing compliance for specialty health plans and vendors. Responsibilities
Performs financial audits and/or financial analyses for Specialty Health Plans. Performs financial analyses or vendor management for the client vendors. Performance claims audits for Specialty Health Plans and vendors. Provide timely and accurate deliverables to ensure financial solvency and claims processing compliance with regulatory and contractual requirements for plan partners, participating provider groups, capitated hospitals, specialty health plans, and vendors. Assist in the creation and implementation of standardized Specialty Health Plans and vendors workpapers and reporting templates. Maintain and document the Financial Compliance Department\'s policies and procedures. Manage quarterly and annual Department of Managed Health Care (DMHC) filing submissions. Cross-train on financial solvency reviews for PPGs, PPs, and capitated hospitals. Serve as primary contact and liaison for CMS claim audit activities with client delegates. Review and update the department\'s Policies and Procedures (P&Ps) annually and ensure management approval prior to submission. Coordinate with Legal Department and Delegation Oversight for monitoring and reporting requests. Provide SME guidance and cross-training; collaborate with interdepartmental teams, leadership, plan partners, and vendors. Support special projects, reporting tools for corrective action plans, and non-compliance notifications. Assist in regulatory requirement assessments and the development of internal processes and procedures with desktop procedures. Identify opportunities where technical solutions can improve business performance; mentor junior staff and interns as needed. Provide training and recommend process improvements. Perform other duties as assigned. Qualifications
Education Required
Bachelor\'s Degree in Accounting or Related Field. In lieu of a degree, equivalent education and/or experience may be considered. Experience Required
At least 3 years of experience in conducting financial audits. At least 5 years of related experience in the managed healthcare industry. Minimum of 2 years of accounting experience. Skills Required
Strong analytical and critical thinking skills. Action-oriented, self-starter, and an excellent motivator. Excellent verbal and written communication skills. Ability to prioritize assignments and work independently with minimum supervision. Professional interfacing with internal and external customers at all levels of the organization. Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint). Licenses/Certifications
Certified Public Accountant (CPA) Certified Internal Auditor (CIA) Candidates must understand financial statements
Financial statement analysis, risk assessment, and communication with Plan partners as needed. Recognize trends in the industry. Conduct audits and identify issues. CAPS with providers as needed (corrective action plans). Cost analysis and root cause analysis. Pay Range for CA, CO, IL, NJ, NY, WA, and DC:
$55/hour to $57/hour. Starting rate may vary based on position, location, education, training, and/or experience. Solugenix will consider qualified applicants with a criminal history pursuant to applicable laws. Applicants do not need to disclose their criminal history or participate in a background check until a conditional job offer is made. After a conditional offer and background check, if there is concern about a conviction directly related to the job, the applicant will have a chance to explain circumstances or challenge the report. About the Client
Our client is one of the world\'s leading health insurance companies based in Los Angeles, CA. About Solugenix
Solugenix is a leader in IT services, delivering technology solutions and managed services to global enterprises. We support regulated industries with compliance-focused solutions and skilled professionals.
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Senior Health Plan Auditor. 3-Month Contract (Possibility of Conversion) based out of Los Angeles, CA (Hybrid). Solugenix is assisting a client, a health insurance company, in this search. Base pay range: $55.00/hr - $57.00/hr. This role is part of a team responsible for planning, execution, reporting, and corrective action plan monitoring of financial solvency and claims processing compliance for specialty health plans and vendors. Responsibilities
Performs financial audits and/or financial analyses for Specialty Health Plans. Performs financial analyses or vendor management for the client vendors. Performance claims audits for Specialty Health Plans and vendors. Provide timely and accurate deliverables to ensure financial solvency and claims processing compliance with regulatory and contractual requirements for plan partners, participating provider groups, capitated hospitals, specialty health plans, and vendors. Assist in the creation and implementation of standardized Specialty Health Plans and vendors workpapers and reporting templates. Maintain and document the Financial Compliance Department\'s policies and procedures. Manage quarterly and annual Department of Managed Health Care (DMHC) filing submissions. Cross-train on financial solvency reviews for PPGs, PPs, and capitated hospitals. Serve as primary contact and liaison for CMS claim audit activities with client delegates. Review and update the department\'s Policies and Procedures (P&Ps) annually and ensure management approval prior to submission. Coordinate with Legal Department and Delegation Oversight for monitoring and reporting requests. Provide SME guidance and cross-training; collaborate with interdepartmental teams, leadership, plan partners, and vendors. Support special projects, reporting tools for corrective action plans, and non-compliance notifications. Assist in regulatory requirement assessments and the development of internal processes and procedures with desktop procedures. Identify opportunities where technical solutions can improve business performance; mentor junior staff and interns as needed. Provide training and recommend process improvements. Perform other duties as assigned. Qualifications
Education Required
Bachelor\'s Degree in Accounting or Related Field. In lieu of a degree, equivalent education and/or experience may be considered. Experience Required
At least 3 years of experience in conducting financial audits. At least 5 years of related experience in the managed healthcare industry. Minimum of 2 years of accounting experience. Skills Required
Strong analytical and critical thinking skills. Action-oriented, self-starter, and an excellent motivator. Excellent verbal and written communication skills. Ability to prioritize assignments and work independently with minimum supervision. Professional interfacing with internal and external customers at all levels of the organization. Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint). Licenses/Certifications
Certified Public Accountant (CPA) Certified Internal Auditor (CIA) Candidates must understand financial statements
Financial statement analysis, risk assessment, and communication with Plan partners as needed. Recognize trends in the industry. Conduct audits and identify issues. CAPS with providers as needed (corrective action plans). Cost analysis and root cause analysis. Pay Range for CA, CO, IL, NJ, NY, WA, and DC:
$55/hour to $57/hour. Starting rate may vary based on position, location, education, training, and/or experience. Solugenix will consider qualified applicants with a criminal history pursuant to applicable laws. Applicants do not need to disclose their criminal history or participate in a background check until a conditional job offer is made. After a conditional offer and background check, if there is concern about a conviction directly related to the job, the applicant will have a chance to explain circumstances or challenge the report. About the Client
Our client is one of the world\'s leading health insurance companies based in Los Angeles, CA. About Solugenix
Solugenix is a leader in IT services, delivering technology solutions and managed services to global enterprises. We support regulated industries with compliance-focused solutions and skilled professionals.
#J-18808-Ljbffr