Senior Specialist
Molina Healthcare
Senior Specialist
Molina Healthcare
Runs health plans for government programs
Provides senior level support for operational business process redesign, communications and change management initiatives that result in operational efficiencies and/or an increase customer satisfaction. Responsible for back-end operationalization of policies, standardization of system set-up and resourcing support for all departments and health plans. Assists in development of enterprise business process improvement methodologies and implementation of business process improvement capabilities company-wide.
Essential Job Duties
• Partners with various business functions and units to identify, document, and baseline all relevant processes.
• Utilizes industry techniques to improve the effectiveness and efficiency of business processes.
• Conducts interviews with staff and leadership to assess internal business processes within a department or function, and review/ensure compliance with existing organizational policies and procedures/standard operating procedures (SOPs) and other internal, external and regulatory guidelines.
• Reviews and researches information to evaluate compliance of a process or function and corresponding written documentation.
• Researches and analyzes fundamental issues in business process development.
• Uses analytical skills and data insights to identify process/informational variances.
• Diagrams and evaluates existing processes.
• Develops metrics that provide data for process measurement - identifying indicators for future improvement opportunities.
• Recommends, implements, and documents continuous improvement process best practices to support the business.
• Summarizes and documents assessment outcomes and recommendations, and ensures that they are appropriately communicated (written and verbal) to process owners and leadership.
• Collaborates with process owners to maintain and/or create business process documentation and workflows related to core operations functions.
• Conducts ongoing reviews and updates complex business processes in collaboration with functional subject matter experts and other stakeholders.
• Serves as liaison between core operations and internal and external auditors for all formal core operations audits that are not compliance related.
• Coordinates, facilitates and documents audit walkthroughs.
• Researches, collects or generates requested documentation; provides timely and accurate responses, both written and verbal.
• Researches and responds to questions submitted by internal and external auditors.
• Researches requested documentation and collaborates in partnership with teams and other functional areas as needed.
• Provides training and support to new and existing process improvement team members.
Required Qualifications
• At least 3 years of process improvement/analytics experience, or equivalent combination of relevant education and experience.
• Data analysis skills.
• Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions.
• Strong organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
• Ability to work cross-collaboratively across a highly matrixed organization and establish and maintain effective relationships with internal and external stakeholders.
• Effective verbal and written communication skills.
• Microsoft Office suite (including Excel) and applicable software programs proficiency.
Preferred Qualifications
• Proven analytical experience within an operations or process-focused environment.
• Health care experience.
• Lean Six Sigma certification.
• Previous audit and/or oversight experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Salary Range: $44936.59 - $97362.61 ~ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Runs health plans for government programs
Molina Healthcare runs health insurance plans for people covered by Medicaid, Medicare and state insurance marketplaces, with a focus on people who need affordable access to care. Its local health plans coordinate medical services and support members with complex health needs, including people eligible for both Medicaid and Medicare. Members receive care through networks of doctors, hospitals and other providers, while the plans manage benefits, process claims and arrange care support. The company earns premiums from government programs and members, and pays the cost of covered healthcare services. Molina was founded in 1980 and is headquartered in Long Beach, California.
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