Healthcare Configuration Audit Specialist

Molina Healthcare, Inc.; Boise (ID); On-site; USD 30,000 - 56,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare, Inc. is seeking an Audit/Quality Assurance professional to support configuration oversight for audits, focusing on claims, enrollment, contracts, and provider data.

The role emphasizes accuracy, regulatory alignment, and clear audit commentary to drive improvements in processing and compliance. Key duties include conducting focal audits, documenting findings, and coordinating resolutions within established timelines, with emphasis on Medicare, Medicaid, and marketplace

Qualifications

• 2+ years of auditing experience in a health care operations setting or equivalent education/experience.
• Experience with a claims processing system and verification of documentation.
• Strong attention to detail and effective verbal/written communication.

Responsibilities

• Review documentation for enrollments, provider contracts, demographics, and claims guidelines to ensure accuracy in core processing modules.
• Conduct focal audits on processed transactions to ensure alignment with original documentation.
• Audit vendor outcomes and verify accuracy against documentation.
• Document audit results clearly and timely for leadership.
• Track unresolved errors and coordinate resolution with business partners within 30 days.
• Assess adjudication of claims for coding accuracy, fraud, or processing errors, per policies.

Skills

Auditing in healthcare

Claims processing knowledge

Documentation review

Attention to detail

Communication skills

Tools

Microsoft Excel

Job description

Molina Healthcare, Inc. is seeking an Audit/Quality Assurance professional to support configuration oversight for audits, focusing on claims, enrollment, contracts, and provider data.

The role emphasizes accuracy, regulatory alignment, and clear audit commentary to drive improvements in processing and compliance. Key duties include conducting focal audits, documenting findings, and coordinating resolutions within established timelines, with emphasis on Medicare, Medicaid, and marketplace