Senior auditor [h1.location_city]

divh2Job Title / h2pProvides senior level audit support for delegation oversight activities. Responsible for ensuring delegates are compliant with the applicable state, federal, contractual requirements, National Committee for Quality Assurance (NCQA), and Molina requirements for the health plan(s) they support. Identifies risk and non-compliance, issues corrective action, and actively manages the corrective action process to completion reducing and managing Molinas risk. / ppstrongEssential Job Duties / strong / pulliLeads and performs pre-delegation, annual audits, and ensures all components of audit activities comply with contractual, regulatory, and accreditation requirements. / liliConducts detailed and focused audits on delegates policies, procedures, case files and evidence of ongoing monitoring to ensure quality and cost-effective provision of delegated services. / liliEngages delegate leadership to educate, collaborate, and / or remediate risks to Molina. / liliLeverages highly skilled analytical insights and experience to identify delegate systemic issues and risks that impact the business; collaborates with health plans and / or corporate departments and other business owners to actively address and mitigate risk to Molina. / liliConducts analysis of audit issues to identify root-causes, develops and issues corrective action plans (CAPs), and documents follow-up to ensure successful remediation. / liliPrepares, tracks and provides audit finding reports in accordance with departmental requirements. / liliPrepares, submits and presents audit reports to delegation oversight committees. / liliPresents audit findings to delegates, and makes recommendations for improvements based on audit results. / liliCollaborates with delegation oversight leadership to develop and maintain assessment tools. / liliMakes independent decisions on complex issues and project components. / liliServes as subject matter expert on policies, regulations, contractual requirements and delegate contracts for the relevant area. / liliRemains current on applicable regulatory, contractual and accreditation requirements and standards; interprets regulatory, contractual and accreditation changes and assesses their impact on the relevant area. / liliConducts outreach to multiple department heads regarding key performance indicator (KPI) data analysis for quarterly meetings. / liliProvides training and support to new and existing delegation oversight team members. / li / ulpstrongRequired Qualifications / strong / pulliAt least 3 years of managed care experience, including at least 2 years of delegation oversight auditing experience, or equivalent combination of relevant education and experience. / liliAbility to work independently or in a team, support multiple projects at once, and perform other duties or special projects as required. / liliAbility to collaborate cross-functionally across a highly matrixed organization. / liliStrong attention to detail and organizational skills. / liliStrong critical-thinking, and problem-solving / analytical abilities. / liliStrong interpersonal and verbal / written communication skills. / liliMicrosoft Office suite proficiency (including Excel), and ability to learn / navigate new software programs. / li / ulpstrongPreferred Qualifications / strong / pulliCertified Credentialing Specialist (CCS), Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN), Certified Clinical Coder (CCD), Certified Medical Audit Specialists (CMAS), Certified Professional in Healthcare Management (CPHM) and / or other health care certification / licensure. If licensed, license must be active and unrestricted in state of practice. / li / ulpTo all current Molina employees : If you are interested in applying for this position, please apply through the Internal Job Board. / ppMolina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V. / ppPay Range : $77,969 - $128,519 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level. / p / div