Healthcare Services Operations Support Auditor (Bilingual) (PST)

JOB DESCRIPTION 

Job Summary

The Non-Clinical Auditor is responsible for conducting detailed audits of member service interactions, including call recordings and documentation, to assess accuracy, completeness, and compliance. This role ensures adherence to regulatory and organizational standards by monitoring for compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and state and federal guidelines and requirements. 

PST Work hours: 10:30 AM-7 PM

Bilingual Spanish Preferred

Essential Job Duties 
• Performs audits of member service interactions, including call recordings and documentation, to assess accuracy, completeness, and compliance. 
• Reports outcomes, identifies areas of re-training for staff, and communicates findings to leadership. 
• Ensures auditing approaches follow a Molina standard in approach and tool use. 
• Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 
• Demonstrates professionalism in all communications. 
• Adheres to departmental standards, policies, protocols. 
• Maintains detailed records of auditing results. 
• Assists healthcare services with developing training materials or job aids as needed to address findings in audit results. 
• Meets minimum production standards related to non-clinical auditing. 
• May conduct staff trainings as needed. 
• Communicates with quality, and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct. 

Required Qualifications 
• At least 2 years health care experience, preferably in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience. 
• Strong analytical and problem-solving skills. 
• Ability to work in a cross-functional, professional environment. 
• Ability to work on a team and independently. 
• Excellent verbal and written communication skills. 
• Microsoft Office suite/applicable software program(s) proficiency. 

Preferred Qualifications 

Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) non-clinical review/auditing 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