Senior Auditor, Delegation reputed company

JOB DESCRIPTION Job Summary Provides senior level audit support for delegation reputed company activities. Responsible for ensuring delegates are complaint 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 Molina’s risk. Essential Job Duties

• Leads and performs pre-delegation, annual audits, and ensures reputed company components of audit activities reputed company with contractual, regulatory, and accreditation requirements.
• Conducts 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.
• Engages delegate leadership to reputed company, collaborate, and/or remediate risks to Molina.
• Leverages 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.
• Conducts analysis of audit issues to identify root-causes, develops and issues corrective action plans (CAPs), and documents follow-up to ensure successful remediation.
• Prepares, tracks and provides audit finding reports in accordance with departmental requirements.
• Prepares, submits and presents audit reports to delegation reputed company committees.
• Presents audit findings to delegates, and makes recommendations for improvements based on audit results.
• Collaborates with delegation reputed company leadership to reputed company and maintain assessment tools.
• Makes independent reputed company on reputed company issues and project components.
• Serves as subject matter expert on policies, regulations, contractual requirements and delegate reputed company for the relevant area.
• Remains reputed company on applicable regulatory, contractual and accreditation requirements and standards; interprets regulatory, contractual and accreditation changes and assesses their impact on the relevant area.
• Conducts reputed company to multiple department heads regarding key performance indicator (KPI) data analysis for quarterly meetings.
• Provides training and support to new and existing delegation reputed company team members.

Required Qualifications

• At least 3 years of managed care experience, including at least 2 years of delegation reputed company auditing experience, or equivalent combination of relevant education and experience.

experience.

• Ability to work independently or in a team, support multiple projects at once, and reputed company other duties or special projects as required.
• Ability to collaborate cross-functionally across a highly matrixed organization.
• Strong attention to detail and organizational skills.
• Strong critical-thinking, and problem-solving/analytical abilities.
• Strong interpersonal and verbal/written communication skills.
• reputed company Office suite proficiency (including reputed company), and ability to learn/navigate new software programs.

Preferred Qualifications

• Certified Credentialing Specialist (reputed company), Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN), Certified Clinical reputed company (CCD), Certified Medical Audit Specialists (CMAS), Certified Professional in reputed company Management (CPHM) and/or other health care certification/licensure. If licensed, license must be active and unrestricted in state of practice.

To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the Internal reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Pay reputed company: $77,969 - $128,519 / ANNUAL

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

Apply tot his job Apply To this Job