Compliance Specialist
Molina Healthcare - Troy, MI

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Molina Healthcare has an immediate opportunity for a Compliance Specialist at our Troy, MI location. This role is responsible for conducting audits to ensure compliance with CMS regulatory requirements. Trains local staff on compliance and quality requirements. Investigates quality of care issues and suspected fraud, waste, and abuse.

DUTIES AND RESPONSIBILITIES
  • Assists with audits to assess compliance with contractual and regulatory requirements.
  • Monitoring activities involving the effective execution of corrective action requirements.
  • Revises / develops audit tools to reflect current standards, contract changes, and regulations.
  • Participates in the development of compliance training/educational materials and providing training as assigned, educating departments on specific compliance requirements.
  • Works with all business segments to increase awareness of the importance of the compliance, anti-fraud plan, and code of conduct.
  • Direct communications with departments to ensure consistent understanding of contractual, state, and federal regulatory requirements.
  • Assisting and supporting compliance-related projects and initiatives, participating collaboratively in staff meetings, committee, projects, and teams to resolve issues and meeting compliance program goals.
  • Assist with HIPAA liaison responsibilities.
  • Assist with, investigates, and reports on suspected fraud, abuse, and noncompliance.
  • Other duties as assigned
STATE PLAN / DEPARTMENT SPECIFIC DUTIES AND RESPONSIBILITIES
  • Position required to assure MHM is achieving and maintaining full execution of the compliance plan. Will be used to assist with compliance investigations including HIPAA and FWA, support auditing, and support 2013 MDCH compliance review changes to the program integrity section that include quarterly state reporting.
KNOWLEDGE, SKILLS AND ABILITIES
  • Excellent verbal and written communication skills
  • Ability to abide by Molina’s policies
  • Maintain regular attendance based on agreed-upon schedule
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
  • Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
QUALIFICATIONS

Required Education:
  • Bachelor Degree preferred or equivalent work experience.
Required Experience:
  • Minimum three years prior experience working with a compliance program desired.
  • Prior experience in government programs and/or auditing within managed health care preferred.
  • Knowledge of managed care contractual and regulatory requirements for Medicaid and/or Medicare
  • Ability to develop, organize, analyze, and implement procedures.
  • Ability to review, analyze and interpret regulatory requirements in a clear and concise manner.
  • Clear and concise report writing and presentation skills.
  • Strong orientation to deadlines and details with ability to meet competing deadlines.
  • Ability to work and communicate effectively with employees at all levels.
  • Decisive and exercises good judgment under pressure.
  • Excellent interpersonal, analytical and communication skills.
  • Intermediate skill with MS Office tools (including Excel, Word, Power Point.
To all current Molina employees if you are interested in applying for this position please fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online. Be sure to let us know you are a current employee by selecting “Molina Employee (current) in the source section of the online application.

Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Molina Healthcare - 2 years ago - save job
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Navigating the murky waters of federal health care plans is no easy feat, but Molina Healthcare's mission is to help Medicaid and...