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As part of Molina’s response to the COVID-19 pandemic, unless otherwise prohibited by law, new hires with a start date of November 1, 2021 or later will be required to be fully vaccinated.

Senior Auditor, Health Plan Operations (Remote in Texas)

Molina Healthcare Texas Job ID 2009901
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  • Works with assigned managers, supervisors, or other team members to identify training needs.
  • Delivers training as applicable to assigned teams, including job specific training for new hires.
  • Stays abreast of changes in the organization and new requirements. Performs training as necessary.
  • Classifies quality audit criteria based upon contractual requirements.
  •  Conducts quality audits based upon criteria on contractual requirements.
  • Monitors operations processes and contracted requirements for adherence to policy and service level agreements.
  • Confirms that operational service level agreements are met via monitoring and reporting, report discrepancies and conduct follow up.
  • Works with supervisors/managers to enhance DLP's from quality findings.
  • Meets regularly with assigned team management to determine best practices and possible procedure changes within the department.
  • Assesses training needs and conducts training for assigned teams or units in the MMIS environment.
  • Performs auditing activities in the Medicaid environment to ensure work is performed in accordance with internal and client expectations.
  • Works with cross functional teams to identify and implement business process improvement opportunities.  
  • Ability to organize work, set priorities, meet critical deadlines and manage multiple projects.
  •  Experience with TX Medicaid, Medicare and Marketplace programs and regulations (HHSC, TDI, CMS) including monitoring for regulatory updates
  • Experience with oversight of delegated entities including monitoring regulatory deliverables, key performance metrics, and compliance auditing.
  • Creating and tracking corrective action plans (CAPs) to effective remediation.
  •  Monitoring data for performance trends.
  • Development of pre-delegation audit programs for onboarding of new delegated entities.
  • Participation delegation oversight committee.
  • Ability to interpret contract language and evaluate to ensure compliance, identify gaps, and recommend improvements.
  •  Auditing of provider data and credentialing activities.
  • Comfortable with creating, reviewing, and auditing policy and procedure documentation.
  • Good communication skills and comfortable working with peers, leadership and external stakeholders.
  • Detail oriented and organized.
  • Demonstrates the ability to cooperate with a variety of people and achieve results.
  •  Strong process related analytical skills.
  •  Ability to provide performance feedback in a professional manner.
  •  Excellent verbal and written communication skills.
  •  Ability to abide by Molina's policies.
  •  Ability to maintain attendance to support required quality and quantity of work.
  •  Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
  •  Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.

  • Associate's Degree or equivalent experience
  • 3+ years related experience
  • Experience conducting training sessions for internal and external groups
  • Bachelor's Degree or equivalent experience preferred.
  • Preferred Experience:
    • Experience with claims processing and provider relations in a Medicaid environment.
    • Experience tracking and maintaining quality metrics.

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

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: 10/04/2021


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