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Sr Specialist, Delegation Oversight- Claims Auditor (CA only)

Company: Molina Healthcare
Location: Garden Grove
Posted on: August 4, 2022

Job Description:

The selected candidate must currently be located in the state of California (but will work remote) JOB DESCRIPTION Job Summary Responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with DMHC and DHCS requirements including delegation standards and requirements contained in the Molina Medical Compliance and Fraud, Waste and Abuse Program. KNOWLEDGE/SKILLS/ABILITIES

  • Coordinates, conducts, and documents delegation assessments as necessary to comply with state, federal, NCQA, and any other applicable requirements.
  • Prepares status reports from Delegated Entities. Develops corrective action plans when deficiencies are identified, and documents follow-up to completion. Ensures compliance with reporting requirements by tracking the receipt and completeness of reports.
  • Develops corrective action plans when compliance issues are identified, and document follow-up to completion.
  • Assists with meetings of the Delegation Oversight Committee, including the preparation of documents for committee oversight of delegated functions.
  • Works with Network Management team to develop and maintain delegation agreements and assessment tools.
  • Prepares delegation oversight document evidence for state monitoring visits and NCQA accreditation surveys and participates on Molina's work team. JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent combination of education and experience. Required Experience
    • 3+ years managed care experience (claims auditing).
    • Experience with Medi-Cal claims processing and/or auditing required
    • Min. 1 year experience completing delegation oversight assessment/audits.
    • Data analysis experience. Required License, Certification, Association Valid State Driver's License (for travel within the state of California to conduct onsite audits as needed) Preferred Education Bachelor's Degree in Business or Health Care related field. Preferred Experience
      • 5 years managed care experience.
      • 2 years experience completing delegation oversight assessments/audits.
      • Quality management/regulatory experience with increasing responsibility. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Keywords: Molina Healthcare, Garden Grove , Sr Specialist, Delegation Oversight- Claims Auditor (CA only), Accounting, Auditing , Garden Grove, California

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