Lead Configuration Quality/Audit Analyst

Job Description Job Summary Responsible for accurate and timely auditing of critical information on claims databases. Maintains critical auditing and outcome information. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate accuracy of configuration and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. Responsible for work load assignment to auditors. Train and coach new employees . Provide clear and concise results and comments to leaders about focal and and random audits across all states. Monitors and controls workflow. Ensures that audits are conducted in a timely fashion and in accordance with unit standards. Knowledge/Skills/Abilities u2022 Trains audit staff on configuration functionality, enhancements and updates. u2022 Accurately interprets end to end business requirements and able to confirm outcomes meet the specific state/federal requirements. u2022 Creates management reporting tools to enhance audit communication on configurations accuracy results and/or audit findings. u2022 Writes complex ad-hoc reports u2022 Interprets and validates accuracy of complex MRDT and other configuration update scripts u2022 Assists manager in establishing standards, guidelines, and best practices for the audit team u2022 Interprets and validates accuracy of complex reports and automated configuration processes/solutions u2022 Assist manager in establishing peer review standards and methodology u2022 Leads peer reviews u2022 Research and review new audit tools and techniques and provide recommendations to management u2022 Validates accuracy of new complex configuration processes/solutions u2022 Verifies accuracy of MRDT, fee schedule, premium, AutoQ, and other file load packages u2022 Interprets complex business problems and technical issues u2022 Effectively communicates audit findings and/or outcomes through review meetings, written communications, and, workflow diagrams. u2022 Helps drive solution to successful implementation by directing technical and business resources during all phases of the software development life cycle u2022 Gains a deep understanding of Molina claims life cycle and all processes that affect claims payment u2022 Develops and maintain standards and best practices for the team u2022 Mentors junior auditors u2022 Participates in or leads project meetings u2022 Understands QNXT, AutoQ, and MCG functionality and schema u2022 Writes Requirements for BRDs/FRDs and Reports without needing mentoring u2022 Suggests schema/solution. Works with technical resource to determine best solution. u2022 Manages complex projects from requirements to deployment, including work assignment, prioritization, issue triage etc. u2022 Researches complex issues u2022 Acts as a team lead, assigning and prioritizing work for other team members as needed Job Qualifications REQUIRED EDUCATION: Associates Degree or equivalent combination of education and experience REQUIRED EXPERIENCE: + 5 + years of experience with oversight, auditing, government regulations/compliance, operations + Must have strong understanding of QNXT claims processes + Must be able to identify and troubleshoot claim discrepancies by utilizing benefit and provider contracts, regulatory requirements and various claims related resources + Strong experience using Microsoft Office applications such as Excel, Word, Outlook, Powerpoint and Teams + Effective written and verbal communication skills. + Flexibility to meet changing business requirements, strong commitment to high quality, on time delivery + Previous process improvement experience + Previous experience mentoring or training peers PREFERRED EDUCATION: Bacheloru2019s Degree or equivalent experience PHYSICAL DEMANDS: Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $155,508 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-10-20