Primary Location : US-CA-Long Beach-MOLINA300
Job : Exchange and Duals
Organization : Corporate
Job Posting : Aug 25, 2020, 4:34:10 PM
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Job Description Job Summary:
The Director of Audit, Medicare A&G will provide strategic
leadership in regards to Appeals and Grievances compliance and
internal audit plans, investigations, risk assessments and policies
and procedures serving as a true content expert in health care
regulations. The Director of Audit, Medicare A&G will be the
Subject Matter Expert (SME) in CMS requirements and MMP 3-Way
Contract. Additionally, the Director of Audit will apply internal
audit theory and practice with the ability to evaluate the design
and operating effectiveness, make recommendations, as needed, for
training enhancements and process improvements. Additionally, the
Director of Audit Medicare A&G will serve as the key compliance
liaison to Corporate Compliance, MMP Plans, and the Medicare
• Develops a Quality Plan that meets CMS Medicare and MMP 3-way
• Identifies regulatory risks through audit activities and
communicate audit findings to A&G Leadership .
• Collaborate with Functional owners to help mitigate issues
from reoccurring and help sustain compliance.
• Creates and implements improvement plans in productivity,
quality, and member experience.
• Provides reoccurring Compliance status updates to Senior
• Creates, implements, and refines quality KPIs reporting to
• Support and maintain reporting of timeliness KPIs in
accordance with Medicare Compliance.
• Responsible for managing and recruiting Appeals and Grievances
• In partnership with Training Team, develop and update training
program in accordance with State and Federal guidelines.
Job Qualifications Required Education:
Bachelor's degree or equivalent experience
• 7+ years of experience working in the following areas:
Audit, Medicare Managed Care and Appeals & Grievances.
• Working knowledge of Medicare, MMP, and CMS
• Medicare/MMP Audit and Appeals & Grievances
• 10+ years of experience working in the following
areas: Audit, Medicare Managed Care and Appeals & Grievances.
• Extensive knowledge of Medicare, MMP, and CMS
• Extensive Medicare/MMP Audit and Appeals & Grievances
To all current Molina employees: If you are interested in
applying for this position, please apply through the intranet job
Molina Healthcare offers a competitive benefits and compensation
package. Molina Healthcare is an Equal Opportunity Employer (EOE)