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JOB DESCRIPTION Job Summary

Provides support for claims audit activities including identification of incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors.

Essential Job Duties

+ Audits the adjudication of claims using standard principles, and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing of claims errors.

+ Prepares, tracks and provides claims audit findings reports according to established timelines.

+ Presents claims audit findings and makes recommendations to leadership for improvements based on audit results.

+ Reviews timeliness of claims processing to ensure compliance with contractual and state/federal requirements.

+ Maintains minimum claims audit accuracy rate per contractual guidelines.

+ Supports claims department initiatives to improve overall claims function efficiency.

+ Meets claims audit department quality and production standards.

+ Completes basic claims projects as assigned.

+ Experience in reviewing high $ claims, claims payment method.

Required Qualifications

+ At least 2 years of experience in a clerical role in a claims, and/or customer service setting - preferably in managed care, or equivalent combination of relevant education and experience.

+ Audit, research, and data entry skills.

+ Organizational skills and attention to detail.

+ Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.

+ Customer service experience.

+ Effective verbal and written communication skills.

+ Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

+ Health care claims auditing/billing 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: $18.04 - $42.2 / HOURLY

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