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Director, Financial Compliance

Date: Jun 4, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 5142 

 

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 financial and claims auditing activities. The Director is responsible for the oversight and operational activities of the following units: Internal Claims Oversight, Delegated Network Claims Oversight, Overpayment Reconciliation and Reporting, and Internal Controls.

Major Functions (Duties and Responsibilities)

 

1. Direct the Internal Claims Oversight team to include routine audits, focused audits and Fraud, Waste and Abuse (FWA) audits.
2. Collaborate with Provider Services, Contracting, Claims and Configuration to reduce the impact of payment errors, implement process improvements and increase Provider satisfaction.
3. Implement an accounting process to facilitate the reconciliation of Provider refunds, Vendor invoices and open receivables.
4. Implement a robust reporting process to assist the Auditing, Accounting, Claims and Provider Services Teams to identify areas for auditing and process improvement opportunities, develop relevant dashboards for each Team and create report cards summarizing Providers’ performance.
5. Responsible for the Delegated Network Oversight activities, including claims payment processes, regulatory compliance, and financial stability.
6. Responsible for the Internal Controls activities, including routine and ad hoc audits to identify and mitigate financial risks.
7. Encourage and facilitate Process Improvement activities to improve operational processes and procedures.
8. Participate, practice, and promote the IEHP Mission, Vision and Values, LEAN principles/practices and Strategic Priorities to all IEHP Team Members, building effective Team Member engagement and enterprise-wide collaboration.
9. Provide coaching and guidance to the Management Team to ensure we promote collaboration and empowerment for our Team Members.

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

Seven (7) years of experience leading, managing and motivating teams in a managed care environment. Five (5) years of experience overseeing Medi-Cal and Medicare claims auditing.

Preferred Experience

 

Five (5) years of experience with Lean process improvement principals preferred.

Education Qualifications

 

Bachelor’s degree in Accounting, Finance, Healthcare Administration, or other related field from an accredited institution required.

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. 

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.

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

 

Starting Salary: $144,976.00  - $184,849.60  

Pay rate will commensurate with experience

 

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. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core 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 a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles