Sr Specialist, Process Review (Remote)

Lensa; City of Albany (NY); Remote; USD 77,000 - 117,000; Full time

Job summary

A leading healthcare company is seeking a professional responsible for business process redesign and change management. The role involves collaboration with various departments to ensure compliance and enhance operational efficiency. Ideal candidates will have strong analytical skills and experience in managed care operations.

Qualifications

• Four years proven analytical experience within an operations or process-focused environment.
• Knowledge of managed care enrollment processes and claims processing.

Responsibilities

• Conduct interviews to assess compliance with policies and procedures.
• Summarize and document assessment outcomes and recommendations.
• Serve as liaison for Core Operations audits.

Skills

Analytical

Problem Solving

Communication

Education

Associate's Degree

Bachelor's Degree

Job description

1 day ago Be among the first 25 applicants

Get AI-powered advice on this job and more exclusive features.

Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Job Description

Job Summary

Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide.

Knowledge/Skills/Abilities

• Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines.
• Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement.
• Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management.
• Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions.
• Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related.
• Coordinate, facilitate and document audit walkthroughs.
• Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal.
• Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed..
  
  

Job Qualifications

Required Education

Associate's Degree or two years of equivalent experience

Required Experience

• Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations:
• Analytical experience within managed care operations.
• Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions.
  
  

Preferred Education

Bachelor's Degree

Preferred Experience

• Six years proven analytical experience within an operations or process-focused environment.
• Previous audit and/or oversight experience.
  
  

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 - $116,835 / ANNUAL

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

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Information Technology

• Industries

  IT Services and IT Consulting

Referrals increase your chances of interviewing at Lensa by 2x

Get notified about new Senior jobs in Albany, NY.

Senior Director, HR Business Partner - (Remote - Boston & Raleigh only)

Albany, New York Metropolitan Area 1 day ago

Senior Design Manager - Architectural and Engineering Projects

Technical Author (multiple roles and seniority levels)

Senior Manager, Business Data Analysis and Processing

Director, Strategy - Managed Care (REMOTE)

Regional Director, Quality Solutions (Remote Eastern Time Zone)

Director, Data Governance (Data Lake)- REMOTE

Albany, NY $107,028.00-$208,705.00 4 months ago

Supervisor, EMR Remote Operations - Global Operations

AVP, Call Center Operations (Inbound & Outbound) - REMOTE

Albany, NY $120,000.00-$180,000.00 2 weeks ago

Albany, New York Metropolitan Area 1 day ago

National Account Executive of Strategic Partnerships

Medical Director Specialty Medical Services & Medicaid Perf.

Vice President, Compliance Business Partner - Hybrid Remote

Schenectady, NY $100,000.00-$130,000.00 6 months ago

Albany, NY $107,028.00-$250,446.00 2 days ago

Legal Industry - Middle Market Relationship Manager

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.