MHSr Specialist, Process Review
Molina Healthcare is a FORTUNE 500 company focused on providing government-sponsored healthcare services, including Medicaid and Medicare, across the United States.
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..
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.
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About the job
Apply before
Posted on
Job type
Full Time
Experience level
Senior
Location requirements
Hiring timezones
United States +/- 0 hoursSkills
Business ProcessChange ManagementCompliance AssessmentsAnalytical SkillsProblem SolvingBusiness KnowledgeDocumenting Operational ProcessesWorkflow ManagementAudit ManagementCare ManagementClaimsConfigurationCommunication SkillsWorkflowsManaged Care ProcessesEnrollment ProcessCAS Claims ProcessingProvider ManagementOversight Experience
About Molina Healthcare
Learn more about Molina Healthcare and their company culture.
Molina Healthcare is a FORTUNE 500, multi-state health care organization dedicated to providing quality health care services under Medicaid and Medicare programs. With a commitment to ensuring that every person and family has access to quality health care, Molina operates in numerous states across the United States. The organization serves over 5 million members through locally operated health plans and strives to address health disparities with innovative solutions.
With a foundation built in 1980 by Dr. C. David Molina, the organization has grown from one clinic in Long Beach, California, to become a leader in government-sponsored health care services. Molina Healthcare specializes in managed care, providing a comprehensive range of health services from preventive care to specialized treatment plans. One of Molina's most significant achievements includes integrating care for those eligible for both Medicaid and Medicare, showing a commitment to delivering high-quality, coordinated health care across diverse populations. Their focus on community engagement ensures that members are empowered to manage their health effectively.
MHMolina Healthcare
Company size
1001-5000 employees
Founded in
1980
Chief executive officer
Joseph Zubretsky
Markets
Employees live in
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