Appeals & Grievances Regulatory Audit Readiness Specialist II

Company: L.A. Care Health Plan
Location: Los Angeles
Posted on: June 1, 2025

Job Description:

Appeals & Grievances Regulatory Audit Readiness Specialist IIJob Category: Customer ServiceLocation: Los Angeles, CA, US, 90017Position Type: Full TimeRequisition ID: 11884Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (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. Our mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents.The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of guidelines and protocols to ensure readiness for all regulatory audits. This position will develop, with the assistance of CSC management, a successful auditing strategy for various processes within CSC, including enrollment processing, member materials, outbound health risk assessment calls, and compliance with regulatory obligations.This position will complete targeted, focused, and random audits related to member interactions and outcomes to ensure compliance. Results will be provided to management with recommendations for corrective actions. The position requires leading audit situations and reporting findings while ensuring action plans are created and executed.Duties

• Audit readiness: Perform audit procedures for Customer Solution Center departments, including identifying issues, reviewing evidence, and documenting processes.
• Regulatory compliance: Collaborate with management to assess operational processes and evaluate policies against regulations.
• Assist in document preparation for regulatory and internal audits.
• Collaborate with Business Analyst to analyze results of Quality Assurance scorecards.
• Perform other duties as assigned.Education RequiredBachelor's Degree or equivalent education and/or experience.ExperienceRequired: A minimum of 5 years of experience in regulatory auditing in a healthcare environment, including experience with Medi-Cal and Medicare.SkillsRequired:
• Advanced proficiency in Word, Excel, and Access.
• Strong analytical and team-building skills.
• Ability to work effectively with diverse team members.
• Ability to formulate recommendations for quality improvements.
• Ability to multi-task and streamline operations.
• Strong interpersonal and organizational skills.Physical RequirementsLightAdditional InformationThis position requires work after hours, on weekends, and holidays, with a hybrid remote schedule and occasional flexibility in hours/shift.Salary Range Disclaimer: The expected pay range is based on factors such as geography, experience, education, and the market. The range is subject to change.Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental, and Vision
• Wellness Program
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Keywords: L.A. Care Health Plan, Highland , Appeals & Grievances Regulatory Audit Readiness Specialist II, Accounting, Auditing , Los Angeles, California