About the position
The Compliance Specialist position at Molina Healthcare is a remote role based in New York, primarily focused on supporting compliance operations across various product lines. This role involves significant travel, up to 90%, within the New York Metropolitan area, and is responsible for conducting audits, reporting, and ensuring compliance with applicable regulations.
Responsibilities
• Perform Plan Required Reporting.
• Interpret and analyze Medicare, Medicaid, and Medicare Medicaid Plan Required Reporting Technical Specifications.
• Create and maintain monthly and quarterly Key Performance Indicator (KPI) reports.
• Support management with New York State Assistor Concerns (Tracking/Action/Reporting).
• Conduct secret shop visits of Molina's Sales team and sites to determine compliance with applicable rules and regulations and assess customer service.
• Assess Facilitated Enrollers, Managed Long Term Care, and Medicaid Advantage Plus Representatives' product knowledge.
• Document and submit detailed reports about the visits, including time, date, and staff interactions.
• Conduct telephonic audits of Molina's Facilitated Enrollers.
• Conduct enrollment application audits.
Requirements
• BA/BS/BC degree in Healthcare Administration or equivalent employment experience of 4+ years in Health Care or related field required.
• 4 years' experience in the health care industry in a related field desired.
Nice-to-haves
• Preferred education includes BA/BS/BC in Healthcare Administration.
• Preferred experience includes 4 years' experience in the health care industry in a related field.
Benefits
• Competitive benefits and compensation package.
Apply Now
Apply Now