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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..

+ Ability to write SQL queries

+ Experience with QNXT configuration

+ Experience with troubleshooting and analyzing issues.

+ Experience working in a Medicare environment is highly preferred.

+ Claims adjudication experience is highly preferred. **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.