KNOWLEDGE, SKILLS & ABILITIES (Generally, the occupational knowledge and specific technical and professional skills and abilities required to perform the essential duties of this job):

• Trains audit staff on configuration functionality, enhancements and updates.
•  Accurately interprets end to end business requirements and able to confirm outcomes meet the specific state/federal requirements.
• Creates management reporting tools to enhance audit communication on configurations accuracy results and/or audit findings
•  Writes complex ad-hoc report
•  Interprets and validates accuracy of complex MRDT and other configuration update scripts 
• Assists manager in establishing standards, guidelines, and best practices for the audit team 
• Interprets and validates accuracy of complex reports and automated configuration processes/solutions
• Assist manager in establishing peer review standards and methodolog
•  Leads peer reviews
•  Research and review new audit tools and techniques and provide recommendations to management
•  Validates accuracy of new complex configuration processes/solutions
• Verifies accuracy of MRDT, fee schedule, premium, AutoQ, and other file load packages 
• Interprets complex business problems and technical issues
• Effectively communicates audit findings and/or outcomes through review meetings, written communications, and, workflow diagrams.
• Helps drive solution to successful implementation by directing technical and business resources during all phases of the software development life cycle
•  Gains a deep understanding of Molina claims life cycle and all processes that affect claims payment
• Develops and maintain standards and best practices for the team
• Mentors junior auditors 
• Participates in or leads project meetings
• Understands QNXT, AutoQ, and MCG functionality and schema
• Writes Requirements for BRDs/FRDs and Reports without needing mentoring
•  Suggests schema/solution.  Works with technical resource to determine best solution.
• Manages complex projects from requirements to deployment, including work assignment, prioritization, issue triage etc.
•  Researches complex issues\
• Acts as a team lead, assigning and prioritizing work for other team members as needed

JOB FUNCTION:

• Responsible for accurate and timely auditing of critical information on claims databases. 
• Maintains critical auditing and outcome information. Synchronizes data among operational and claims systems and application of business rules as they apply to each database.
• Validate accuracy of configuration and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.
• Responsible for work load assignment to auditors. 
• Train and coach new employees . 
• Provide clear and concise results and comments to leaders about focal and and random audits across all states. 
• Monitors and controls workflow.
•  Ensures that audits are conducted  in a timely fashion and in accordance with unit standards.

REQUIRED EDUCATION:

Bachelor’s Degree or equivalent combination of education and experience

REQUIRED EXPERIENCE:

5-6 Years

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

PREFERRED EDUCATION:

Graduate Degree or equivalent experience

PREFERRED EXPERIENCE:

7+ Years

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: 

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