Sr Specialist, Process Review (Remote)
Molina Healthcare Albany, New York; Everett, Washington; Boise, Idaho; Davenport, Iowa; Utah; Idaho; Florida; New Mexico; Cleveland, Ohio; Idaho Falls, Idaho; Rio Rancho, New Mexico; Spokane, Washington; Detroit, Michigan; Bellevue, Nebraska; Tacoma, Washington; Nebraska; Santa Fe, New Mexico; Madison, Wisconsin; Sterling Heights, Michigan; Meridian, Idaho; Kenosha, Wisconsin; Grand Island, Nebraska; Macon, Georgia; Houston, Texas; Roswell, New Mexico; Savannah, Georgia; Nampa, Idaho; New York; Layton, Utah; San Antonio, Texas; Salt Lake City, Utah; Ann Arbor, Michigan; Ohio; Kentucky; Racine, Wisconsin; Texas; Akron, Ohio; Georgia; Wisconsin; Phoenix, Arizona; Warren, Michigan; Seattle, Washington; Mesa, Arizona; Scottsdale, Arizona; Austin, Texas; Columbus, Ohio; Kearney, Nebraska; Cedar Rapids, Iowa; Miami, Florida; Yonkers, New York; Owensboro, Kentucky; Sioux City, Iowa; Covington, Kentucky; Green Bay, Wisconsin; St. Petersburg, Florida; Omaha, Nebraska; Jacksonville, Florida; Las Cruces, New Mexico; Buffalo, New York; Tampa, Florida; New York, New York; Bellevue, Washington; Tucson, Arizona; Rochester, New York; Caldwell, Idaho; Lincoln, Nebraska; Iowa City, Iowa; Dayton, Ohio; Bowling Green, Kentucky; Albuquerque, New Mexico; Syracuse, New York; Milwaukee, Wisconsin; Fort Worth, Texas; Columbus, Georgia; Michigan; Iowa; Orem, Utah; Lexington-Fayette, Kentucky; Dallas, Texas; Provo, Utah; Des Moines, Iowa; Augusta, Georgia; Atlanta, Georgia; West Valley City, Utah; Washington; Grand Rapids, Michigan; Chandler, Arizona; Orlando, Florida; Cincinnati, Ohio; Louisville, Kentucky; Vancouver, Washington Job ID 2031487
Job Description
Job Summary
Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide.
Knowledge/Skills/Abilities
• Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines.
• Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement.
• Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management.
• Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions.
• Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related.
• Coordinate, facilitate and document audit walkthroughs.
• Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal.
• Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed..
Job Qualifications
Required Education
Associate's Degree or two years of equivalent experience
Required Experience
• Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations:
• Analytical experience within managed care operations.
• Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions.
Preferred Education
Bachelor's Degree
Preferred Experience
• Six years proven analytical experience within an operations or process-focused environment.
• Previous audit and/or oversight experience.
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.
Job Summary
Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide.
Knowledge/Skills/Abilities
• Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines.
• Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement.
• Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management.
• Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions.
• Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related.
• Coordinate, facilitate and document audit walkthroughs.
• Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal.
• Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed..
Job Qualifications
Required Education
Associate's Degree or two years of equivalent experience
Required Experience
• Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations:
• Analytical experience within managed care operations.
• Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions.
Preferred Education
Bachelor's Degree
Preferred Experience
• Six years proven analytical experience within an operations or process-focused environment.
• Previous audit and/or oversight experience.
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.
Pay Range: $77,969 - $116,835 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 04/30/2025ABOUT OUR LOCATION
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