Covington, KY, 41019, USA
9 days ago
Sr Specialist, Process Review (Remote)
**Job Description** **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. \#PJCore Pay Range: $44,936.59 - $97,362.61 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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