Sr Auditor, Compliance

Molina Healthcare•Long Beach, CA

About The Position

Provides senior level support for compliance auditing activities. Responsible for evaluating Molina's adherence to regulatory requirements, internal policies, and health care industry standards by identifying compliance gaps and recommending improvements to mitigate risk related to fraudulent or abusive practices. Essential 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, facilitate outcome education and share best practices. Ensures adequate documentation supports 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, and determining effect and risk. Identifies, analyzes, and assesses complex enterprise-wide 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. Ensures appropriate implementation and/or corrective action is taken to address risks and issues identified. Meets regularly with operational departments to review data analysis, and assists in the execution and monitoring of corrective measures. Leads in developing instructional materials and provides technical assistance related to compliance and performance audit findings. Assists compliance leadership with developing and publishing compliance and internal control tools and guidance for internal employees as required by contractual requirements/applicable laws and regulations.

Requirements

At least 4 years experience in an audit and/or compliance, or equivalent combination of relevant education and experience.
Knowledge of Medicaid and Medicare contractual requirements, relevant regulatory frameworks and compliance standards.
Knowledge of relevant regulatory frameworks and compliance standards.
Understanding of internal control concepts and risk assessment methodologies.
Strong analytical and problem-solving abilities.
Ability to provide constructive feedback via work paper review.
Strong report writing and presentation abilities.
Attention to detail, and ability to manage multiple projects simultaneously.
Effective verbal and written communication skills.
Microsoft Office suite and applicable software program(s) proficiency.

Nice To Haves

Experience in the health care industry.

Responsibilities

Leads and performs all aspects of an audit, including planning, testing of controls, data analysis, preparing accurate work papers to properly document findings, facilitate outcome education and share best practices.
Ensures adequate documentation supports 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, and determining effect and risk.
Identifies, analyzes, and assesses complex enterprise-wide 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.
Ensures appropriate implementation and/or corrective action is taken to address risks and issues identified.
Meets regularly with operational departments to review data analysis, and assists in the execution and monitoring of corrective measures.
Leads in developing instructional materials and provides technical assistance related to compliance and performance audit findings.
Assists compliance leadership with developing and publishing compliance and internal control tools and guidance for internal employees as required by contractual requirements/applicable laws and regulations.