Compliance Advisor II
Administrative, HR, Business Professionals
Los Angeles, CA, US, 90017
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.
The Compliance Advisor ensures that L.A. Care business units are compliant with all Product Lines' contractual, state and federal regulatory, and accreditation requirements. The Advisor will develop regulatory reports, agendas, minutes and communictions to the Internal Compliance Committee and the Compliance and Quality Committee of the Board of Governors and provide support for the management of external state and federal regulatory audits. The Advisor will prepare executive summaries and reports, develop and conduct training activities for suordinates, peers and L.A. Care business units and lead or participate in interdisciplinary/cross-functional teams. The Advisor shall have a working knowledge of DHCS, CMS, and NCQA requirements, as well as highly developed analytical and critical thinking skills, to serve as a resource to internal business units and external entities. The Advisor may investigate, assist with coordination and management of teams and workgroups, project documentation and workflows, draft and complete presentations, auditing and monitoring of performance standards, and other duties as assigned. The Advisor should have excellent written and verbal communications skills. Although the Advisor's primary responsiblity is providing support and for the Regulatory Affairs unit, the Advisor will also advise and support the Manager, Director, and Chief Compliance Officer on other duties as assigned to support the mission and responsiblities of the Compliance Department and to support the business operations of L.A. Care Health Plan.
Analyze and interpret contractual, state and federal regulatory, and accreditation requirements.
Participate in and conduct compliance functions, including, but not limited to, developing compliance tools and validating implementation of new requirements and corrective action plans.
Work with internal business units to prepare reports for distribution to internal Committees and external entities.
Faciliate cross-function teams including internal business units and/or external entities to correct performance deficiencies.
Prepare and conduct trainings for internal business units and/or external entities.
Review, approve and suggest revisions on policies and procedures, member/provider materials, compliance work plans, etc., as well as submit to regulatory entities for approval.
Work with internal business units to identify gaps, develop and implement corrective action plans and facilitate monitoring activities to ensure compliance with regulatory requirements.
Review internal and external inquiries and collaborate with all levels of organizational management, business units and our Delegates to ensure timely, accurate, and complete submissions. This includes self-disclosures of non-compliance issues to the regulators.
Develop, maintain, and monitor Internal Compliance Committee (ICC) Charter, Compliance Program and key performance indicators. Responsible for the development of Board/committee write-ups to be presented at the Compliance & Quality (C&Q) and Internal Compliance Committee (ICC) meetings.
Bachelor's Degree in Public Health or Related Field
In lieu of degree, equivalent education and/or experience may be considered.
Master's Degree in Public Health or Related Field
At least 3-5 years in a managed care setting.
Experienced in health care auditing and monitoring (preferably in Appeals, Grievances, Quality Improvement, Utilization Management and so forth) and developing audit tools.
Demonstrated experience developing and delivering training programs and making presentations.
Minimum 2 years Medi-Cal, Medicare or commercial product compliance. Regulatory change management and risk management experience and/or business continuity experience in a health plan or hospital setting preferred.
Excellent written and verbal communication skills. Advanced skills in Visio, PowerPoint and SharePoint preferred.
Strong verbal and writing
Knowledge in health care compliance.
Ability to manage multiple priorities and projects and meet deadlines.
Knowledge of Medi-Cal Managed Care principles and/or government programs.
Persuasion Skills: 1.Ensuring organizational compliance with all state and federal Medi-Cal Program requirements reduces L.A. Care's risk to state/federal sanctions and fines- communicate required action to senior management/BoG, Plan Partner staff. 2. Internal audit program and internal reviews reindicators of the quality of health care services provided to L.A. Care Medi-Cal members. This serves to help maintain a quality and solvent provider network and avert provider network disruptions due to poor quality of care and/or insolvent providers. All areas of risk/noncompliance are to be identified, reported and monitored.
L.A. Care offers a wide range of benefits including
+ Paid Time Off (PTO)
+ Tuition Reimbursement
+ Retirement Plans
+ Medical, Dental and Vision
+ Wellness Program
+ Volunteer Time Off (VTO)