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Healthcare Services Operations Support Auditor

Healthcare Services Operations Support Auditor

Molina HealthcareYonkers, NY, US
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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.
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    Operation Support • Yonkers, NY, US

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