Financial Compliance Data Manager II
Company: L.A. Care Health Plan
Location: Los Angeles
Posted on: September 21, 2023
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Job Description:
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Accounting/Finance Location: - Los Angeles, CA, US, 90017 Position
Type: - Full Time Requisition ID: - 10016 Salary Range: -
-$102,183.00 -(Min.) - -$124,877.00 -(Mid.) - -$163,492.00
-(Max.)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.
-Job SummaryThe Financial Compliance Data Manager II is responsible
for providing assistance and support to the Claims department to
collect Medicare/ Cal MediConnect (CMC), Organization
Determination, Appeals & Grievances (ODAG) data from Participating
Physician Group (PPG's) and Specialty Health Plans (SHP) . The data
validation template created in visual basic will need to be
maintained and updated as necessary. This position will support PPG
and SHP questions about the technical data collection process. This
position will also support the AB1455 data upload process and
reporting required by the State. This position will assist in the
collection of PPG claims audit populations for audit samples
purposes. This position will also support the annual CMC/ Centers
for Medicare and Medicaid Services (CMS) audit by Advent/ Medicare
Data Validation Audit (MDVA) to validate data integrity. (OMT)
Online Monitoring Tool (OMT) by Gorman) will also be updated and
reported to Regulatory Affairs and Compliance (RAC) for support of
CMS regulatory reporting requirements. -DutiesOversees the updates
and maintains policies and procedure for database manual, as well
as provide continuous training and education to users in order to
improve the processes for inputting and overall database
efficiency. Trains the Medicare data analysts in the collection and
follow-up with PPG's and SHP's on a regular basis. Supports PPG and
SHP technical questions relating to the submission and use of the
data collection template. Assists in the upload of data to Oracle
as necessary. Assists in preparing reports for CMS and/or Gorman
Health Group audits. Prepares custom queries and generates reports
as required. -Supports the quarterly and annual AB1455 data upload
process of MTR data required to be submitted to the State. Prepares
and analyzes data as required. -Maintains CMC/ODAG data collection
template. Modifies parameters to ensure compliance with Medicare
regulatory data standards. Assists in the collection of paid claims
data universes for claims audit samples. Prepares data and sample
selections for the PPG Claims audits. Prepares data reports and
perform analysis as requested. Maintains the Medicare data
validation template. Coordinates data validation with the Claims
department and Medicare Operations and assists in corrective
actions plans if required. Validates data to ensure data is
accurate and complete in the approved CMS format. Supports PPG and
SHP technical questions relating to the submission and use of the
data collection template.Assists in the collection of MTR/CMC paid
claims data for the annual MDVA/Advent audit. Reconciles and
validates data integrity. Prepare reports as requested. -Maintains
and updates Claims Audit automated work papers to ensure updated
Medi-cal rate tables are uploaded and to ensure queries are running
properly.Populates Gorman OMT (Online Line Monitoring Tool) for
Specialty Health Plans which is required by RAC for CMS
requirements.Performs other duties as assigned.Education Required
Bachelor's Degree in Computer Science In lieu of degree, equivalent
education and/or experience may be considered. Education Preferred
Master's Degree ExperienceRequired:
At least 6-8 years experience in a technical function utilizing
multiple software applications with Healthcare HMO
experience.SkillsRequired:
Requires Information Technology (I.T.) programming skills to modify
parameters and to ensure compliance with Medicare regulatory data
standards.Expert knowledge in databases and report writing.Advanced
knowledge of Visual Basic, SQL, Oracle, Access, Hyperion and
Crystal reports.Strong verbal and written communication skills as
well as strong interpersonal skills. -Ability to prioritize
multiple projects without compromising desired timelines.High level
of independent judgment.Must be flexible, organized, and able to
handle multiple tasks simultaneously.Must have keen analytical
skills accompanied by knowledge of the business and technology and
has ability encompasses broad knowledge required from Centers for
Medicare and Medicaid Services(CMS), California Department of
Health Care Services (DHCS), Managed Risk Medical Insurance Board
(MRMIB) and other governing body.Licenses/Certifications
RequiredLicenses/Certifications PreferredRequired TrainingPhysical
Requirements Light Additional InformationSalary Range Disclaimer:
The expected pay range is based on many factors such as geography,
experience, education, and the market. The range is subject to
change.L.A. Care offers -a wide range of benefits including
Nearest Major Market: Los Angeles
Job Segment: Medicare, Claims, Medicaid, Financial, Healthcare,
Insurance, Finance
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Keywords: L.A. Care Health Plan, Los Angeles , Financial Compliance Data Manager II, Executive , Los Angeles, California
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