Healthcare Services Operations Support Auditor

JOB DESCRIPTION

Job Summary

Provides support for non-clinical healthcare services auditing activities. Responsible for performing audits for non-clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

Performs audits of non-clinical staff in utilization management, care management, member assessment, and / or other teams - monitoring for compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and state and federal guidelines and requirements.

Reports outcomes, identifies areas of re-training for staff, and communicates findings to leadership.

Ensures auditing approaches follow a Molina standard in approach and tool use.

Maintains member / provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA).

Demonstrates professionalism in all communications.

Adheres to departmental standards, policies, protocols.

Maintains detailed records of auditing results.

Assists healthcare services with developing training materials or job aids as needed to address findings in audit results.

Meets minimum production standards related to non-clinical auditing.

May conduct staff trainings as needed.

Communicates with quality, and / or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve / correct.

Required Qualifications

At least 2 years health care experience, preferably in utilization management, care management, and / or managed care, or equivalent combination of relevant education and experience.

Strong analytical and problem-solving skills.

Ability to work in a cross-functional, professional environment.

Ability to work on a team and independently.

Excellent verbal and written communication skills.

Microsoft Office suite / applicable software program(s) proficiency.

Preferred Qualifications

Utilization management, care management, behavioral health and / or long-term services and supports (LTSS) non-clinical review / auditing experience.

To all current Molina employees : If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V

Pay Range : $24 - $56.17 / HOURLY

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

Required

Preferred

Job Industries