Quality control analyst serp_jobs.h1.location_city

Audit Manager

Responsible for accurate and timely auditing of critical information on claims databases. Maintains critical auditing and outcome information. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validates accuracy of configuration and ensures adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. Responsible for workload assignment to auditors. Trains and coaches new employees. Provides clear and concise results and comments to leaders about focal and random audits across all states. Monitors and controls workflow. Ensures that audits are conducted in a timely fashion and in accordance with unit standards.

Knowledge / Skills / Abilities :

• Trains audit staff on configuration functionality, enhancements and updates.
• Accurately interprets end to end business requirements and able to confirm outcomes meet the specific state / federal requirements.
• Creates management reporting tools to enhance audit communication on configurations accuracy results and / or audit findings.
• Writes complex ad-hoc reports.
• Interprets and validates accuracy of complex MRDT and other configuration update scripts.
• Assists manager in establishing standards, guidelines, and best practices for the audit team.
• Interprets and validates accuracy of complex reports and automated configuration processes / solutions.
• Assists manager in establishing peer review standards and methodology.
• Leads peer reviews.
• Researches and reviews new audit tools and techniques and provides recommendations to management.
• Validates accuracy of new complex configuration processes / solutions.
• Verifies accuracy of MRDT, fee schedule, premium, AutoQ, and other file load packages.
• Interprets complex business problems and technical issues.
• Effectively communicates audit findings and / or outcomes through review meetings, written communications, and workflow diagrams.
• Helps drive solution to successful implementation by directing technical and business resources during all phases of the software development life cycle.
• Gains a deep understanding of Molina claims life cycle and all processes that affect claims payment.
• Develops and maintains standards and best practices for the team.
• Mentors junior auditors.
• Participates in or leads project meetings.
• Understands QNXT, AutoQ, and MCG functionality and schema.
• Writes Requirements for BRDs / FRDs and Reports without needing mentoring.
• Suggests schema / solution. Works with technical resource to determine best solution.
• Manages complex projects from requirements to deployment, including work assignment, prioritization, issue triage, etc.
• Researches complex issues.
• Acts as a team lead, assigning and prioritizing work for other team members as needed.

Job Qualifications : Required Education :

Required Experience :

Preferred Education :

Physical Demands :

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V. Pay Range : $77,969 - $155,508 / ANNUAL