Director, Financial Compliance (Hybrid)

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.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

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

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.

Work Model Location

Physical Requirements