Auditor, Provider Network (NYC: Social Adult Daycare Centers)

Molina Healthcare•Long Beach, NY

7d•Hybrid

About The Position

Provides audit support for contractual and regulatory compliance for Social Adult Day Centers in accordance with requirements established by state regulations. The role ensures provider adherence to applicable regulations through comprehensive audits, reviews, and investigations ensuring timely resolution and appropriate documentation. The position serves as a primary liaison between providers, internal departments, and regulatory agencies to support compliance, quality oversight, and regulatory readiness across the assigned territory.

Requirements

At least 3 years contract-related experience in the health care field including, but not limited to, provider’s office, managed care organization, or other health care or regulatory environment, or equivalent combination of relevant education and experience.
Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare

Nice To Haves

Reside in Queens is preference
Experience / knowledge of SADC's Compliance requirements (OSHA / ADA)

Responsibilities

Conducts outreach and on-site audits in the Social Adult Care Centers within Molinas Senior Whole Health business segment including prospective and existing center, in accordance with state requirements.
Performs and manages audits, ensuring timely completion and adherence to applicable standards.
Responds to all other time-sensitive requests as required.
Reviews, assesses, and evaluates submitted documentation and proof of compliance based on specific guidelines issued by the regulator. This includes, but is not limited to, review of policies and procedures, facility standards, staffing requirements, and operational practices.
Interprets applicable regulatory guidance to determine compliance status.
Communicates determinations to providers and identify required remediation actions or completion steps, ensuring follow-up until resolution.
Investigates and responds to agency complaints, as well as handle all other related agency requests within established timelines.
Tracks, documents, and maintains accurate records of all actions, communications, audit outcomes, corrective action plans, and follow-up activities, including required reporting to the regulator and other oversight agencies.
Communicates proactively and collaborate with internal departments to ensure regulatory alignment, operational efficiency, and effective resolution of compliance matters.
Trains, mentors, and monitors newly hired team members to ensure consistent application of regulatory standards, audit protocols, and internal procedures.
Approximately 90% travel throughout NYC to conduct on-site audits, complaint investigations, and regulatory reviews in order to meet oversight and compliance requirements.