Compliance Specialist (REMOTE - NY ONLY - Travel Required)

About the position The Compliance Specialist position at Molina Healthcare is a remote role based in New York, primarily focused on supporting compliance operations across various product lines. This role involves significant travel, up to 90%, within the New York Metropolitan area, and is responsible for conducting audits, reporting, and ensuring compliance with applicable regulations. Responsibilities • Perform Plan Required Reporting. • Interpret and analyze Medicare, Medicaid, and Medicare Medicaid Plan Required Reporting Technical Specifications. • Create and maintain monthly and quarterly Key Performance Indicator (KPI) reports. • Support management with New York State Assistor Concerns (Tracking/Action/Reporting). • Conduct secret shop visits of Molina's Sales team and sites to determine compliance with applicable rules and regulations and assess customer service. • Assess Facilitated Enrollers, Managed Long Term Care, and Medicaid Advantage Plus Representatives' product knowledge. • Document and submit detailed reports about the visits, including time, date, and staff interactions. • Conduct telephonic audits of Molina's Facilitated Enrollers. • Conduct enrollment application audits. Requirements • BA/BS/BC degree in Healthcare Administration or equivalent employment experience of 4+ years in Health Care or related field required. • 4 years' experience in the health care industry in a related field desired. Nice-to-haves • Preferred education includes BA/BS/BC in Healthcare Administration. • Preferred experience includes 4 years' experience in the health care industry in a related field. Benefits • Competitive benefits and compensation package.Apply Now

Apply Now