Molina Healthcare

Job Summary Are you dedicated to advancing compliance in healthcare? Join our dynamic team as a Lead Compliance Auditor. Your expertise will be vital in protecting our health plans from regulatory and contractual discrepancies. Your role will significantly contribute to the detection and management of compliance risks, ensuring the integrity and safety of Molina Healthcare. Essential Job Duties Lead and conduct thorough pre-delegation and annual audits to guarantee adherence to all regulatory and accreditation standards. Examine delegate policies, procedures, and case files meticulously, ensuring high-quality service delivery. Work closely with delegate leadership to evaluate risks and create effective solutions together. Leverage your analytical skills to identify systemic issues and collaborate with other departments to mitigate risks. Analyze audit outcomes, determine root causes, and develop comprehensive corrective action plans (CAPs). Prepare and manage...

Job Summary Are you passionate about ensuring compliance in healthcare? Join our team as a Senior Compliance Auditor, where your expertise will play a crucial role in safeguarding our health plans against regulatory and contractual discrepancies. Your work will be instrumental in identifying and managing compliance risks, ultimately upholding the integrity and safety of Molina Healthcare. Essential Job Duties Lead and execute comprehensive pre-delegation and annual audits to ensure all regulatory and accreditation standards are met. Conduct detailed examinations of delegate policies, procedures, and case files to confirm quality service delivery. Collaborate with delegate leadership to assess risks and develop effective solutions. Utilize your analytical skills to pinpoint systemic issues and work with other departments to address and minimize risks. Analyze audit results to identify root causes and formulate corrective action plans (CAPs). Prepare and oversee...

Molina Healthcare is hiring a Certified Coder. This role provides support for medical coding activities, including ensuring that ICD-10 and CPT codes are reported accurately to maintain compliance, and minimize risk and denials. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties Performs on-going member medical chart reviews. Abstracts and reports ICD-10 and CPT diagnosis codes accurately and in compliance with established coding and billing principles - minimizing risk and denials. Demonstrates understanding of current provider office billing practices - ensuring that diagnosis and CPT codes are submitted accurately. Documents results/findings from chart reviews and provides feedback to leadership, providers and office staff. Provides training and education to provider network regarding risk adjustment and coding updates related to risk adjustment. Builds positive relationships between...