What are the responsibilities and job description for the Specialist, Configuration Oversight (healthcare medical claim audits) position at Molina Healthcare Group?
Job Description
Job Description
Work hours will be 7am-3:30pm PST M-F
Job Summary
Responsible for conducting various healthcare Healthcare claim audits including, but not limited to; vendor, focal, audit the auditor. Confirm that documentation is clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains to contracting (benefit and provider), network management, credentialing, prior authorizations, fee schedules, and other business requirements critical to claim accuracy. Maintain audit records, and provide counsel regarding coverage amount and benefit interpretation within the audit process. Provide clear and concise results and comments to leaders about focal audits. Contributes to completion of audits as needed to ensure audits are conducted in a timely fashion and in accordance with audit standards.
Job Duties
Job Qualifications
REQUIRED EDUCATION:
Associate’s Degree or equivalent combination of education and experience
REQUIRED EXPERIENCE, SKILLS & ABILIITIES:
- Minimum 2 years as an operational auditor for at least one core operations function
- Previous examiner/processing experience in at least one core operations functional area
- Strong attention to detail
- Knowledge of using Microsoft applications to include; Excel, Word, Outlook, Powerpoint and Teams
- Ability to effectively communicate written and verbal
- Knowledge of verifying documentation related to updates/changes within claims processing system .
- Experience using claims processing system (QNXT).
PREFERRED EDUCATION:
Bachelor’s Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
3 years healthcare Medical claims auditing
PHYSICAL DEMANDS:
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
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.
Job Info
Job Identification: 2034919
Job Category: Operations
Posting Date: 2025-12-09T19:36:13 00:00
Job Schedule: Full time