LTSS Auditor & Risk Analytics Specialist

Molina Healthcare; Wauwatosa (WI); On-site; USD 36,000 - 71,000; Full time

Job summary

Molina Healthcare is seeking an Audit Specialist to support LTSS auditing activities, including risk-focused reviews of care management records, HCBS, and utilization management. You will identify health and safety risks, validate data quality, and report findings to leadership.

The role emphasizes data-driven improvements, staff training, and strict HIPAA confidentiality. Ideal candidates have 3+ years in healthcare/audit with strong analytical skills and proficiency in Excel.

Qualifications

• 3+ years in healthcare, LTSS or QA/auditing preferred.
• Experience using data/reports to identify trends and improvements.
• Strong analytical and communication skills.

Responsibilities

• Conduct retrospective, concurrent, and targeted audits of LTSS-related records and care coordination activities.
• Review LTSS, HCBS, care management and utilization management to identify risks.
• Document findings, risk levels, action owners, due dates, and evidence.
• Verify corrections through follow-up audits and assess impact on outcomes.
• Maintain HIPAA compliance and confidentiality, following Molina standards.

Skills

Healthcare data analysis

Attention to detail

Problem solving

Verbal and written communication

Microsoft Excel

Education

Bachelor’s degree in healthcare-related field

Tools

Microsoft Office

Job description

Molina Healthcare is seeking an Audit Specialist to support LTSS auditing activities, including risk-focused reviews of care management records, HCBS, and utilization management. You will identify health and safety risks, validate data quality, and report findings to leadership.

The role emphasizes data-driven improvements, staff training, and strict HIPAA confidentiality. Ideal candidates have 3+ years in healthcare/audit with strong analytical skills and proficiency in Excel.