Job Description

Ideal Candidate will have the following experience: Credentialing Audits (i.e., credentialing audits of Practitioners/Providers and/or Facilities), performed NCQA credentialing audits and knowledge Medicaid, CMS, and NCQA standards.

Job Summary
Audits key strategic agreements from inception through completion. Engages and oversees the work of external vendors. Conducts focus audits of vendor self reported results. Audits and validates that key strategic vendors are meeting contractual requirements (e.g., OIG Checks, Site Security Requirements). Audits any Corrective Action Plans supplied by the vendor(s). Conducts and reports on Satisfaction Surveys related to key strategic vendors. Conducts focused financial reviews to confirm key financial terms are being adhered to.

Knowledge/Skills/Abilities
• Classifies quality audit criteria based on contractual requirements.
• Confirms that service level agreements are met via monitoring and reporting, report discrepancies and conduct follow up.
• Conducts focal audits on samples of vendor self-reporting.
• Clearly documents the focal audit outcomes and makes recommendations as necessary.
• Prepares, tracks and provides audit findings reports according to designated timelines.
• Presents audit findings and makes recommendations to management for improvements based on audit results.
• Conducts analysis and uses analytical skills to identify root cause and assist with problem management.
• Ensures auditing approaches follow a Molina standard in approach and tool use.
• Demonstrates the ability to cooperate with a variety of people to achieve results.
• Detail oriented and organized.
• Excellent verbal and written communication skills.
• Need to have a working knowledge of Nebraska State Medicaid, CMS, and NCQA

Job Qualifications

Required Education
Associate's Degree or equivalent combination of education and experience

Required Experience
3-5 Years

Experience with performing NCQA credentialing audits

Experience with identifying potential risks, management of corrective action plans, well versed with handling State regulatory audits

Experience with audit process management (i.e. audit schedules, sending out notifications)

Preferred Education
Bachelor's Degree or equivalent combination of education and experience

Preferred Experience
5-7 Years

Preferred License, Certification, Association
CIA certification

Pay Range: $54,922 - $107,098*

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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.

#PJCorp

#LI-BEMORE