Remote Risk Adjustment Auditor Jobs in California

Provides support for health plan provider engagement activities.  Drives value-based care strategies through risk adjustment and quality improvement activities.  Ensures smaller, less advanced tier II and tier III providers have engagement plans to meet annual quality and risk adjustment goals.  Drives coaching and collaboration with providers to improve performance through regular meetings and action plans.  Addresses practice environment challenges to achieve program goals and improve health outcomes.  Tracks engagement activities using standard tools, facilitates data exchanges, and supports training and problem resolution for assigned providers - driving provider participation in Molina's risk adjustment and quality initiatives.

Essential Job Duties

Provides support for provider engagement activities including enhancing value-based strategies, and risk adjustment/quality improvement initiatives.
Ensures assigned tier II and tier III providers have a provider engagement plan to meet annual quality and risk adjustment performance goals. 
Drives provider partner coaching and collaboration to improve quality performance and risk adjustment accuracy through consistent provider meetings, action item development and execution. 
Addresses challenges/barriers in the practice environment impeding successful attainment of program goals and understands solutions required to improve health outcomes. 
Drives provider participation in Molina risk adjustment and quality efforts (e.g. supplemental data, electronic medical record (EMR) connection, clinical profiles programs) and use of the Molina provider collaboration portal. 
Tracks all engagement and training activities using standard Molina provider engagement tools to measure effectiveness.
Works collaboratively with health plan and shared service partners to ensure alignment to business goals. 
Accountable for use of standard Molina Provider Engagement reports and training materials.  
Facilitates connectivity to internal partners to support appropriate data exchanges, documentation education and patient engagement activities.
Develops, organizes, analyzes, documents and implements processes and procedures as prescribed by health plan and corporate policies.
Communicates effectively with internal and external stakeholders, including providers, practice managers, and medical assistants within assigned provider practices.
Maintains the highest level of compliance.
May require same day out-of-office travel up to 80% of the time, depending upon state/health plan requirements.
 

Required Qualifications

At least 2 years of experience improving provider quality performance through provider engagement, practice transformation, and/or managed care quality improvement initiatives, or equivalent combination of relevant education and experience.
Experience with various managed health care provider compensation methodologies including but not limited to:  fee-for service (FFS), value-based care (VBC), and capitation. 
Working knowledge of quality metrics and risk adjustment practices across all business lines.
Knowledge and understanding of HEDIS/NCQA.
Proficiency with data analysis, manipulation, interpretation and reporting.
Critical-thinking, problem-solving and analytical skills.
Relationship building skills.
Attention to detail and organizational skills.
Ability to implement process improvement initiatives and drive change. 
Ability to work independently in a fast-paced, deadline-driven environment.
Ability to work in a cross-functional highly matrixed organization.
Effective verbal and written communication skills.
Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs.
 

Preferred Qualifications

Experience improving quality performance for Medicaid, Medicare, and/or Marketplace programs.
 

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

Pay Range: $45,390 - $80,511.46 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.