Sr Auditor, Compliance

Job Description

Job Summary

Leads and performs compliance and performance risk audits to validate whether operational departments are operating in accordance with customer contractual requirements and applicable state and federal laws. Through the use of a routine method of review and data analysis, assists in the prevention, detection, correction, monitoring, and auditing of health plan compliance risks. Responsible for assisting operational departments with departmental and internal compliance data collection, trending, and analysis. Works with the departments being audited and provides any education needed and advises on best practices.

Job Duties

• Leads and performs all aspects of an audit, including planning, testing of controls, data analysis, preparing accurate work papers to properly document findings, outcome education and best practices
• Ensures adequate documentation supports the audit findings and complies with Compliance department standards and guidelines
• Leads and prepares objective, accurate and factual formal and informal audit reports summarizing the results of the audit work performed, determining effect and risk
• Identifies, analyzes, and assesses complex enterprise-wide environment, regulatory compliance inquiries and issues and compliance program needs
• Recommends compliance programming, compliance initiatives and internal departmental controls
• Oversees research and applies appropriate Federal, State, and contractually based requirements required to perform specific audits
• Monitors operational metrics and indicators related to compliance performance and coordinates all activities related to non-financial, regulatory audits
• Leads and conducts data based compliance risk assessments and/or audits and monitors operational units for compliance
• Assures appropriate implementation and/or corrective action is taken to address risks and issues identified
• Meets regularly with operational departments to review data analysis and assist in the execution and monitoring of corrective measures
• Leads in developing instructional materials and providing technical assistance related to compliance and performance audit findings
• Assists the Compliance Manager or Officer with developing and publishing compliance and internal control tools and guidance for internal employees as required by the contract, and any applicable laws and regulations

Job Qualifications

REQUIRED EDUCATION:

Bachelor’s degree or equivalent experience

REQUIRED EXPERIENCE:

• 1 – 3 years of experience in data analysis, compliance auditing, program evaluation, management or policy analysis, or related experience
• 3 – 5 years of experience conducting data analysis, health plan operations, compliance, and performance auditing for a health plan
• Displays teamwork and integrity
• Knowledge of Medicare and Medicaid contractual requirements and health plan data analysis and audit processes, internal auditing, healthcare, and operations
• Significant knowledge of operational processes, efficient and effective workflows, and best practices in a managed care organization
• Familiarity with all phases of an audit including planning, analysis, report writing, correction action plan development and follow up education
• Ability to work independently and effectively work with team members at all levels
• Excellent research and analytical skills
• Ability to analyze data and draw conclusions
• Ability to manage multiple projects, including establishing deadlines
• Ability to provide constructive feedback via work paper review and formal/informal education
• Strong written, verbal, and interpersonal communication skills are required
• Proficient in Microsoft Office Product Suite

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: 2031536

Job Category: Legal, Risk, & Compliance

Posting Date: 2025-04-18T16:50:38 00:00

Job Schedule: Full time