Healthcare Services Operations Support Auditor

Molina Healthcare; Grand Rapids (MI); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare company in Grand Rapids, Michigan is seeking a candidate for auditing non-clinical services to ensure compliance with regulatory requirements. The ideal candidate has at least 2 years of healthcare experience and strong analytical skills. This role offers a competitive compensation package and opportunities for professional development.

Qualifications

• Requires at least 2 years of health care experience.
• Strong analytical and problem-solving skills are essential.
• Must be proficient in Microsoft Office.

Responsibilities

• Perform audits of non-clinical staff to ensure compliance.
• Report outcomes and identify areas for retraining.
• Maintain detailed records of auditing results.

Skills

Analytical skills

Problem-solving skills

Communication skills

Teamwork

Microsoft Office proficiency

Education

2+ years healthcare experience

Job description

Overview

Provides support for non-clinical healthcare services auditing activities. Responsible for performing audits for non-clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care.

Responsibilities

• Performs audits of non-clinical staff in utilization management, care management, member assessment, and/or other teams - monitoring for compliance with NCQA, CMS, and state and federal guidelines and requirements.
• Reports outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
• Ensures auditing approaches follow a Molina standard in approach and tool use.
• Maintains member/provider confidentiality in compliance with HIPAA.
• Demonstrates professionalism in all communications.
• Adheres to departmental standards, policies, protocols.
• Maintains detailed records of auditing results.
• Assists healthcare services with developing training materials or job aids as needed to address findings in audit results.
• Meets minimum production standards related to non-clinical auditing.
• May conduct staff trainings as needed.
• Communicates with quality, and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct.

Required Qualifications

• At least 2 years health care experience, preferably in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.
• Strong analytical and problem-solving skills.
• Ability to work in a cross-functional, professional environment.
• Ability to work on a team and independently.
• Excellent verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

• Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) non-clinical review/auditing experience.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $24 - $56.17 / HOURLY

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