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 audit findings, ensuring reporting accuracy that adheres to departmental standards.
- Present audit findings and recommendations to relevant committees and leadership, advocating for necessary improvements.
- Partner with oversight leadership to continuously enhance assessment tools.
- Make independent decisions on intricate issues and project components.
- Act as a subject matter expert for applicable policies, regulations, and contracts.
- Stay informed about current regulatory and accreditation standards, interpreting changes and assessing their implications.
- Engage in outreach to communicate key performance indicators (KPIs) with department leadership effectively.
- Facilitate training and support for both new and existing team members in delegation oversight practices.
Required Qualifications
- A minimum of 3 years of experience in managed care, including at least 2 years specifically in delegation oversight auditing, or a relevant combination of education and experience.
- Ability to operate both independently and as part of a team, effectively managing multiple projects at once.
- Proven collaboration skills to succeed in a highly matrixed organization.
- Detail-oriented with excellent organizational capabilities.
- Exceptional critical thinking and problem-solving abilities.
- Outstanding written and verbal communication skills.
- Proficient in Microsoft Office Suite, particularly in Excel, with the ability to adapt to new software.
Preferred Qualifications
- Certifications such as Certified Credentialing Specialist (CCS), Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN), Certified Clinical Coder (CCD), Certified Medical Audit Specialists (CMAS), Certified Professional in Healthcare Management (CPHM), or other relevant healthcare certifications. All licenses must be active and unrestricted in the respective practice state.
Molina Healthcare is proud to be an Equal Opportunity Employer (EOE) M/F/D/V. We offer a competitive benefits and compensation package. Pay Range: $80,168 - $128,519 annually (actual compensation may vary based on geographic location, work experience, education, and skill level).