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Director, Audit ,Medicare A&G

Company: Molina Healthcare
Location: Long Beach
Posted on: September 12, 2020

Job Description:

Job Description

Primary Location : US-CA-Long Beach-MOLINA300

Job : Exchange and Duals

Organization : Corporate

Job Posting : Aug 25, 2020, 4:34:10 PM

Additional Information : To learn more about Molina Healthcare Careers, follow us on LinkedIn , Twitter  & Facebook . You can also visit Molina Cares to view interactive tutorials on resume & cover letter writing, interviewing and more!

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 Segment.

Knowledge/Skills/Abilities:

• Develops a Quality Plan that meets CMS Medicare and MMP 3-way requirements.

• 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 Leadership.

• Creates, implements, and refines quality KPIs reporting to Medicare Compliance.

• Support and maintain reporting of timeliness KPIs in accordance with Medicare Compliance.

• Responsible for managing and recruiting Appeals and Grievances auditors.

• 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

Required Experience:

•  7+ years of experience working in the following areas: Audit, Medicare Managed Care and Appeals & Grievances.

•  Working knowledge of Medicare, MMP, and CMS requirements.

•  Medicare/MMP Audit and Appeals & Grievances experience/knowledge.

Preferred Experience:

•  10+  years of experience working in the following areas: Audit, Medicare Managed Care and Appeals & Grievances. •  Extensive knowledge of Medicare, MMP, and CMS requirements.

•  Extensive Medicare/MMP Audit and Appeals & Grievances experience/knowledge.

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.

Keywords: Molina Healthcare, Long Beach , Director, Audit ,Medicare A&G, Other , Long Beach, California

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