<p>JOB DESCRIPTION Job Summary</p> <p>Provides support for claims audit activities including identification of incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors.</p> <p>Essential Job Duties</p> <ul> <li>Audits the adjudication of claims using standard principles, and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing of claims errors. </li><li>Prepares, tracks and provides claims audit findings reports according to established timelines. </li><li>Presents claims audit findings and makes recommendations to leadership for improvements based on audit results. </li><li>Reviews timeliness of claims processing to ensure compliance with contractual and state/federal requirements. </li><li>Maintains minimum claims audit accuracy rate per contractual guidelines. </li><li>Supports claims department initiatives to improve overall claims function efficiency. </li><li>Meets claims audit department quality and production standards. </li><li>Completes basic claims projects as assigned. </li><li>Experience in reviewing high $ claims, claims payment method. </li></ul> <p>Required Qualifications</p> <ul> <li>At least 2 years of experience in a clerical role in a claims, and/or customer service setting - preferably in managed care, or equivalent combination of relevant education and experience. </li><li>Audit, research, and data entry skills. </li><li>Organizational skills and attention to detail. </li><li>Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. </li><li>Customer service experience. </li><li>Effective verbal and written communication skills. </li><li>Microsoft Office suite and applicable software programs proficiency. </li></ul> <p>Preferred Qualifications</p> <ul> <li>Health care claims auditing/billing experience. </li></ul> <p>To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.</p> <p>Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V</p> <p>Pay Range: $18.04 - $42.2 / HOURLY</p> <ul> <li>Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. </li></ul> <p>About Us</p> <p>Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.</p>