Lead Configuration Quality/Audit Analyst

Job Description Overview 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 applies business rules as they pertain to each database. Validate accuracy of configuration and ensure adherence to business and system requirements of customers as it relates to contracting, benefits, prior authorizations, fee schedules, and other business requirements. Responsible for workload assignment to auditors. Train and coach new employees. Provide clear and concise results and comments to leaders about focal and random audits across all states. Monitor and control workflow. Ensure that audits are conducted in a timely fashion and in accordance with unit standards.

Responsibilities Trains audit staff on configuration functionality, enhancements and updates. Accurately interprets end to end business requirements and confirms 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 reports. 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. Assists manager in establishing peer review standards and methodology. Leads peer reviews. Researches and reviews new audit tools and techniques and provides 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 solutions 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 maintains 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 resources 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 Qualifications REQUIRED EDUCATION:

Associates Degree or equivalent combination of education and experience

REQUIRED EXPERIENCE:

5 + years of experience with oversight, auditing, government regulations/compliance, operations

Must have strong understanding of QNXT claims processes

Must be able to identify and troubleshoot claim discrepancies by utilizing benefit and provider contracts, regulatory requirements and various claims related resources

Strong experience using Microsoft Office applications such as Excel, Word, Outlook, Powerpoint and Teams

Effective written and verbal communication skills.

Flexibility to meet changing business requirements, strong commitment to high quality, on time delivery

Previous process improvement experience

Previous experience mentoring or training peers

PREFERRED EDUCATION:

Bachelor’s Degree or equivalent experience

PHYSICAL DEMANDS Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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 - $155,508 / ANNUAL

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

#J-18808-Ljbffr