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.
Reporting to the Chief Operating Officer (COO), the Operational Assurance Department (OA) is responsible for implementing, promoting, and maintaining an integrated, proactive Assurance Program that optimizes enterprise operational and requirements-based performance.The Assurance Program is built to be responsive to ongoing market, structural, regulatory, and policy changes, and is aligned with L.A. Care’s quality standards and strategic objectives.
The Operational Assurance Business Analyst III, either individually or collaboratively, researches, elicits, analyzes, communicates, tests, and verifies all requirements applicable to the COO’s organization for all lines of business (Medicaid, Medicare, and Commercial). Documents the requirements and business decisions, their corresponding authority, and the status of compliance with said requirements in a comprehensive function-based index, stratified by sub-function level requirements for each product line, and will leverage the requirements to monitor and oversee all functions within this positions' purview. This role stays knowledgeable of regulatory and policy changes, as well as industry best practices, trends, and innovation through ongoing research, professional development, and peer contact specific to L.A. Care’s ecosystem.
This role establishes Key Performance Indicators (KPIs or Metrics) to systematically assess, track, and trend operational performance with respect to established standards to allow for evidence-based decisions. The Business Analyst III will also examine, and as necessary, strengthen process integrity and controls to manage accountabilities, mitigate risks, and protect the Plan from process waste, enforcement actions, sanctions, and other adverse outcomes, in collaboration with key stakeholders. Supports the development of all initiatives and infrastructure in the COO's organization that are required to achieve L.A. Care’s strategic objectives.
This role works independently and collaboratively, responds resourcefully to change and ambiguity, generates and champions ideas and initiatives, and thoughtfully see the connections within the organization to effectively integrate efforts across units and functions to build a cohesive whole out of operational units. The role calls for an effective communicator who can quickly gather, summarize, and meaningfully discuss dense, complex content clearly with all levels of the L.A. Care organization, including Executive Leadership, stakeholders, facilitators, and partners, and external regulating bodies.
Under the general guidance of the Senior Manager, the SBA:
Elicits, documents, analyzes, communicates, tests, verifies, and systematically tracks requirements for the operational units reporting to the COO.
Reviews policies and procedures, internal controls, and processes to identify gaps and opportunities for improved performance and for the reporting of related analytics.
Responsible for maintaining documentation to support evidence of compliance with all requirements, for the reporting of performance data.
Oversees all phases of the operational performance, including helping to communicate federal and state regulatory changes to operational areas, performing impact, gap, and risk analyses for Leadership, developing and monitoring metrics to track ongoing fidelity to these requirements, and taking corrective action to remediate issues of non-compliance.
Partners with the functional business leaders to coordinate reviews and prepares for internal and regulatory audits; examines audit findings and responds to citied deficiencies; and, make recommendations for corrective actions and monitor internal and external corrective action plans.
Develops key performance indicators, alerting requirements, and supporting metrics, to proactively inform the L.A. Care organization, senior Leadership, and relevant committees, including the Internal Compliance Committee (ICC) of possible risks and issues with compliance, and develop remediation and corrective action plans as appropriate.
Reports analytical performance metrics on requirements, which may be in the form of visualizations such as graphs, charts and dashboards, detailing the significant results they deduced to inform senior-level business stakeholders, so they may make informed decisions.
Performs other duties as assigned.
Minimum 5 years of experience in contract and/or regulatory and/or accreditation requirements analysis in managed care or other related industry; or, experience in external regulatory or governing entity audit preparation; or in Healthcare Compliance, or other Compliance-related field. Higher Education may be considered in lieu of the required years of experience.
Experience in contract, legal, or regulatory topics; a complex business setting, local, State, or Federal government entity, managed care, or other related industry.
Regulatory search, business writing, Excel, PowerPoint, Word, Outlook.
Demonstration of both qualitative and quantitative analytical skills.
Proven ability to work with a diverse group of people, including external entities, physicians, support staff, coworkers and management.
Demonstrated ability to research issues and bring about resolution either directly or with the assistance of others.
Demonstrated critical thinking and problem solving skills.
Strong written and verbal communication skills.
Strong elicitation and process documentation skills.
Strong organizational and communication skills to build and foster effective relationships.
Governance, Risk and Compliance (GRC) Systems, Tableau
L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.