Posted : Saturday, August 10, 2024 03:29 AM
Job Requisition ID: 10817
Position Summary/Position
Under the direction of the Senior Director of Financial Compliance, the Director of Financial Compliance is responsible for leading, directing, and coordinating all auditing and monitoring activities related to financial viability and claims processing requirements.
The Director, Financial Compliance is responsible for the oversight and operational activities of the following units: IPA Financial Compliance, Internal Claims Oversight, Delegated Network Claims Oversight, and Overpayment Reconciliation and Reporting.
Major Functions (Duties and Responsibilities) 1.
Responsible for the oversight of all functional areas of the Financial Compliance Department.
2.
Provide leadership in the development, implementation, and coordination of audits for the financial and claims processing oversight of IEHP’s delegated entities.
3.
Oversee the compliance and financial viability of all delegated entities through monitoring, auditing, and reporting.
4.
Direct the organization, review, and timely submission of the sub-contractor Medical Loss Ratio (MLR) reporting to the State.
5.
Oversee the collaboration of data collection and reporting for the Rate Development Template (RDT).
6.
Direct and oversee the Internal Claims Oversight team to include routine audits, focused audits, reporting and feedback.
7.
Collaborate with Provider Services, Contracting, Claims and Configuration to reduce the impact of payment errors, implement process improvements and increase Provider satisfaction.
8.
Oversee the accounting process of reconciling Provider refunds, Vendor invoices and open receivables.
9.
Direct the reporting process to assist the Auditing, Accounting, Claims and Provider Services Teams to identify areas for auditing and process improvement opportunities, using relevant dashboards for each Team and report cards summarizing Providers’ performance.
10.
Encourage and facilitate LEAN Process Improvement activities to improve operational processes and procedures.
11.
Participate, practice, and promote the IEHP Mission, Vision and Values, and Strategic Priorities to all IEHP Team Members, building effective Team Member engagement and enterprise-wide collaboration.
12.
Provide coaching and guidance to the Management Team to ensure collaboration and empowerment for IEHP Team Members.
13.
Any other duties as required ensuring Health Plan operations are successful.
Major Functions (Duties and Responsibilities) Cont Supervisory Responsibilities Leader: Administers Hires, Terminations, and Performance Reviews Experience Qualifications A minimum of seven (7) years of experience leading, managing and motivating teams in a managed care environment is required.
Five (5) years of experience overseeing claims processing and financial viability audits required.
Preferred Experience Education Qualifications Bachelor’s degree in Accounting, Finance, Healthcare Administration, or other related field from an accredited institution required.
In lieu of the required degree, a minimum of eight (8) years of additional relevant work experience is required for this position.
This experience is in addition to the minimum years listed in the Experience Requirements above.
Preferred Education Master’s degree in Business Administration, Accounting, Finance, Public Health, or related field from an accredited institution preferred.
Professional Certification Professional Licenses Drivers License Required Yes, must have a valid California Driver's License.
Knowledge Requirement Must have knowledge of the principles and practices of managed care as well as Medi-Cal and Medicare programs, regulations, and reporting requirements.
Must have knowledge of Generally Accepted Accounting Principles (GAAP) and solid understanding of DMHS, DHCS, and CMS rules governing financial compliance.
Skills Requirement Strong leadership, sound decision-making and strong organizational skills.
Excellent oral and written communication skills.
Abilities Requirement Ability to build successful relationships across the organization.
Commitment to Team Culture The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture.
A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
Working Conditions Sedentary work in an office environment.
Position is eligible for Hybrid work location upon completing the necessary steps and receiving HR approval.
All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.
Work Model Location Hybrid Physical Requirements Keyboarding: Traditional - FREQUENTLY Keyboarding: Other - FREQUENTLY Use of computer mouse - FREQUENTLY Hearing: One-on-One - FREQUENTLY Hearing: In a group - FREQUENTLY Hearing: Over the Telephone/Cell Phone - FREQUENTLY Hearing: Conference Speakers/Video Calls/Radio Calls - FREQUENTLY Communicate: Information/ideas verbally - FREQUENTLY Alternate Sit/Stand or Walk at Will - FREQUENTLY Turning/rotation of wrist or hand - FREQUENTLY Near Visual Acuity - FREQUENTLY Perform complex and varied tasks - FREQUENTLY Sitting - FREQUENTLY Lighting - CONSTANTLY Indoors - CONSTANTLY Develop and maintain positive work relationships - CONSTANTLY Regular contacts: co-workers, supervisor - FREQUENTLY Decision-making - FREQUENTLY Lead/Influence Others - FREQUENTLY Work review - FREQUENTLY Rapid Pace of work - FREQUENTLY Control of work pace - FREQUENTLY Problem Solving - FREQUENTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Regular and reliable attendance - CONSTANTLY A reasonable salary expectation is between $153,670.
40 and $195,936.
00, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire.
We are also one of the largest employers in the region, designated as “Great Place to Work.
” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.
5 million members.
And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace.
As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come.
Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
The Director, Financial Compliance is responsible for the oversight and operational activities of the following units: IPA Financial Compliance, Internal Claims Oversight, Delegated Network Claims Oversight, and Overpayment Reconciliation and Reporting.
Major Functions (Duties and Responsibilities) 1.
Responsible for the oversight of all functional areas of the Financial Compliance Department.
2.
Provide leadership in the development, implementation, and coordination of audits for the financial and claims processing oversight of IEHP’s delegated entities.
3.
Oversee the compliance and financial viability of all delegated entities through monitoring, auditing, and reporting.
4.
Direct the organization, review, and timely submission of the sub-contractor Medical Loss Ratio (MLR) reporting to the State.
5.
Oversee the collaboration of data collection and reporting for the Rate Development Template (RDT).
6.
Direct and oversee the Internal Claims Oversight team to include routine audits, focused audits, reporting and feedback.
7.
Collaborate with Provider Services, Contracting, Claims and Configuration to reduce the impact of payment errors, implement process improvements and increase Provider satisfaction.
8.
Oversee the accounting process of reconciling Provider refunds, Vendor invoices and open receivables.
9.
Direct the reporting process to assist the Auditing, Accounting, Claims and Provider Services Teams to identify areas for auditing and process improvement opportunities, using relevant dashboards for each Team and report cards summarizing Providers’ performance.
10.
Encourage and facilitate LEAN Process Improvement activities to improve operational processes and procedures.
11.
Participate, practice, and promote the IEHP Mission, Vision and Values, and Strategic Priorities to all IEHP Team Members, building effective Team Member engagement and enterprise-wide collaboration.
12.
Provide coaching and guidance to the Management Team to ensure collaboration and empowerment for IEHP Team Members.
13.
Any other duties as required ensuring Health Plan operations are successful.
Major Functions (Duties and Responsibilities) Cont Supervisory Responsibilities Leader: Administers Hires, Terminations, and Performance Reviews Experience Qualifications A minimum of seven (7) years of experience leading, managing and motivating teams in a managed care environment is required.
Five (5) years of experience overseeing claims processing and financial viability audits required.
Preferred Experience Education Qualifications Bachelor’s degree in Accounting, Finance, Healthcare Administration, or other related field from an accredited institution required.
In lieu of the required degree, a minimum of eight (8) years of additional relevant work experience is required for this position.
This experience is in addition to the minimum years listed in the Experience Requirements above.
Preferred Education Master’s degree in Business Administration, Accounting, Finance, Public Health, or related field from an accredited institution preferred.
Professional Certification Professional Licenses Drivers License Required Yes, must have a valid California Driver's License.
Knowledge Requirement Must have knowledge of the principles and practices of managed care as well as Medi-Cal and Medicare programs, regulations, and reporting requirements.
Must have knowledge of Generally Accepted Accounting Principles (GAAP) and solid understanding of DMHS, DHCS, and CMS rules governing financial compliance.
Skills Requirement Strong leadership, sound decision-making and strong organizational skills.
Excellent oral and written communication skills.
Abilities Requirement Ability to build successful relationships across the organization.
Commitment to Team Culture The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture.
A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
Working Conditions Sedentary work in an office environment.
Position is eligible for Hybrid work location upon completing the necessary steps and receiving HR approval.
All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.
Work Model Location Hybrid Physical Requirements Keyboarding: Traditional - FREQUENTLY Keyboarding: Other - FREQUENTLY Use of computer mouse - FREQUENTLY Hearing: One-on-One - FREQUENTLY Hearing: In a group - FREQUENTLY Hearing: Over the Telephone/Cell Phone - FREQUENTLY Hearing: Conference Speakers/Video Calls/Radio Calls - FREQUENTLY Communicate: Information/ideas verbally - FREQUENTLY Alternate Sit/Stand or Walk at Will - FREQUENTLY Turning/rotation of wrist or hand - FREQUENTLY Near Visual Acuity - FREQUENTLY Perform complex and varied tasks - FREQUENTLY Sitting - FREQUENTLY Lighting - CONSTANTLY Indoors - CONSTANTLY Develop and maintain positive work relationships - CONSTANTLY Regular contacts: co-workers, supervisor - FREQUENTLY Decision-making - FREQUENTLY Lead/Influence Others - FREQUENTLY Work review - FREQUENTLY Rapid Pace of work - FREQUENTLY Control of work pace - FREQUENTLY Problem Solving - FREQUENTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Regular and reliable attendance - CONSTANTLY A reasonable salary expectation is between $153,670.
40 and $195,936.
00, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire.
We are also one of the largest employers in the region, designated as “Great Place to Work.
” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.
5 million members.
And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace.
As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come.
Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
• Phone : NA
• Location : Rancho Cucamonga, CA
• Post ID: 9023821399