Solugenix
Base pay range
$55.00/hr - $57.00/hr Contract
4+ Month Contract (Possibility of Conversion) Job ID
25-09680 Overview
Solugenix is assisting a client, a health insurance company, in their search for a Senior Health Plan Auditor. This 4+ month contract opportunity is based out of Los Angeles, CA (Remote). 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. Provides 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. Assists in the creation and implementation of standardized Specialty Health Plans and vendors workpaper and reporting templates. Responsible for the documentation and maintenance of the Financial Compliance Department's policies and procedures. Responsible for collection and completion of the quarterly and annual Department of Managed Health Care (DMHC) filing submissions. Being cross trained on financial solvency reviews for PPGs, PPs, and capitated hospitals. Serves as primary contact and liaison for the Centers for Medicare and Medicaid Services (CMS) claim audit section of the client delegates. Annually reviews and updates the department's Policies and Procedures (P&Ps). Ensures that any new or updated Policy and Procedure is reviewed and approved by management prior to submission. Accountable for the completion of requests from the Legal Department, Delegation Oversight's monitoring oversight and reporting. Serves as subject matter expert in assigned areas and cross-training initiatives. Responsible for the overall communication and collaboration with interdepartmental personnel, leadership, specialty health plans, and vendors. Supports the design, implementation, and reporting of special projects. Supports the design and implementation of reports and tools for corrective action plan issuance and non‑compliance notifications. Supports the assessment, communication, and implementation of regulatory requirements that may impact internal processes. Supports the formalization of key internal processes and monitoring tools with desktop procedures and applicable policies and procedures development. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Provides training, recommend process improvements, and mentor junior‑level staff, department interns, etc. as needed. Performs other duties as assigned. Qualifications
Education: Bachelor's Degree in Accounting or Related Field. In lieu of a degree, equivalent education and/or experience may be considered. Experience: At least 3 years of experience in conducting financial audits. Experience: At least 5 years of related experience in the managed healthcare industry. Experience: Minimum of 2 years of accounting experience. Skills
Strong analytical and critical thinking skills. Action‑oriented, self‑starter, and an excellent motivator. Excellent verbal and written communication skills. Able to prioritize assignments, and able to independently with minimum supervision. Ability to interface professionally with both internal and external customers at all levels of the organization. Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint). Must have Managed care, health care, insurance background financial audit/analyst experience. Must have any of the following certifications: CMA OR CIA OR CPA OR CFE OR CISA. Supporting the Financial audit/Claims Audit, Financial Solvency operations. Support State Compliance Filing, AB1455. Licenses/Certifications (Must hold one of the below certifications):
Certified Public Accountant (CPA) Certified Internal Auditor (CIA) Pay Range for CA, CO, IL, NJ, NY, WA, and DC:
$55.00/hr to $57.00/hr Client
Our client is one of the world's leading health insurance companies based out of Los Angeles, CA.
#J-18808-Ljbffr
$55.00/hr - $57.00/hr Contract
4+ Month Contract (Possibility of Conversion) Job ID
25-09680 Overview
Solugenix is assisting a client, a health insurance company, in their search for a Senior Health Plan Auditor. This 4+ month contract opportunity is based out of Los Angeles, CA (Remote). 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. Provides 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. Assists in the creation and implementation of standardized Specialty Health Plans and vendors workpaper and reporting templates. Responsible for the documentation and maintenance of the Financial Compliance Department's policies and procedures. Responsible for collection and completion of the quarterly and annual Department of Managed Health Care (DMHC) filing submissions. Being cross trained on financial solvency reviews for PPGs, PPs, and capitated hospitals. Serves as primary contact and liaison for the Centers for Medicare and Medicaid Services (CMS) claim audit section of the client delegates. Annually reviews and updates the department's Policies and Procedures (P&Ps). Ensures that any new or updated Policy and Procedure is reviewed and approved by management prior to submission. Accountable for the completion of requests from the Legal Department, Delegation Oversight's monitoring oversight and reporting. Serves as subject matter expert in assigned areas and cross-training initiatives. Responsible for the overall communication and collaboration with interdepartmental personnel, leadership, specialty health plans, and vendors. Supports the design, implementation, and reporting of special projects. Supports the design and implementation of reports and tools for corrective action plan issuance and non‑compliance notifications. Supports the assessment, communication, and implementation of regulatory requirements that may impact internal processes. Supports the formalization of key internal processes and monitoring tools with desktop procedures and applicable policies and procedures development. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Provides training, recommend process improvements, and mentor junior‑level staff, department interns, etc. as needed. Performs other duties as assigned. Qualifications
Education: Bachelor's Degree in Accounting or Related Field. In lieu of a degree, equivalent education and/or experience may be considered. Experience: At least 3 years of experience in conducting financial audits. Experience: At least 5 years of related experience in the managed healthcare industry. Experience: Minimum of 2 years of accounting experience. Skills
Strong analytical and critical thinking skills. Action‑oriented, self‑starter, and an excellent motivator. Excellent verbal and written communication skills. Able to prioritize assignments, and able to independently with minimum supervision. Ability to interface professionally with both internal and external customers at all levels of the organization. Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint). Must have Managed care, health care, insurance background financial audit/analyst experience. Must have any of the following certifications: CMA OR CIA OR CPA OR CFE OR CISA. Supporting the Financial audit/Claims Audit, Financial Solvency operations. Support State Compliance Filing, AB1455. Licenses/Certifications (Must hold one of the below certifications):
Certified Public Accountant (CPA) Certified Internal Auditor (CIA) Pay Range for CA, CO, IL, NJ, NY, WA, and DC:
$55.00/hr to $57.00/hr Client
Our client is one of the world's leading health insurance companies based out of Los Angeles, CA.
#J-18808-Ljbffr