Sr Specialist, Delegation Oversight- Claims Auditor (CA only)
Company: Molina Healthcare
Location: Garden Grove
Posted on: August 4, 2022
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.
- Coordinates, conducts, and documents delegation assessments as
necessary to comply with state, federal, NCQA, and any other
- 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
- 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
- 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
- Min. 1 year experience completing delegation oversight
- 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
- 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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