- Salary Range: $59810.6 - $129589.63 ~ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
KNOWLEDGE, SKILLS & ABILITIES (Generally, the occupational knowledge and specific technical and professional skills and abilities required to perform the essential duties of this job):
- 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 report
- 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
- Assist manager in establishing peer review standards and methodolog
- Leads peer reviews
- Research and review new audit tools and techniques and provide 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 maintain 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 FUNCTION:
- 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.
- Validate accuracy of configuration and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.
- Responsible for work load assignment to auditors.
- Train and coach new employees .
- Provide clear and concise results and comments to leaders about focal and 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.
REQUIRED EDUCATION:
Bachelor’s Degree or equivalent combination of education and experience
REQUIRED EXPERIENCE:
5-6 Years
REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:
PREFERRED EDUCATION:
Graduate Degree or equivalent experience
PREFERRED EXPERIENCE:
7+ Years
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
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
