Analyst, Business

Molina Healthcare; Northern (KY); Hybrid; USD 45,000 - 97,000; Full time

Job summary

Molina Healthcare is seeking a driven professional to interpret regulatory and functional requirements for coverage, reimbursement, and processing systems. You will collaborate with health plans, product teams, and governance committees to ensure alignment with regulatory baselines and internal requirements.

The role emphasizes requirement documentation, UAT facilitation, and cross-functional coordination, including state-specific compliance work.

Qualifications

• At least 2 years of experience in a managed care organization, health insurance or equivalent field.
• Policy/government legislative review knowledge.
• Strong analytical and problem-solving skills.
• Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams.
• Previous success in a dynamic and autonomous work environment.

Responsibilities

• Develops and maintains requirement documents related to coverage, reimbursement and other system changes to align with regulatory baseline and health plan requirements.
• Facilitates user acceptance testing; including creation of UAT scenarios and defect tracking.
• Monitors sources to ensure updates are aligned.
• Leads development and management/interpretation review process with key partner organizations.
• Conducts analysis to identify root cause and assist with problem management related to state requirements.
• Communicates requirement interpretations and changes to health plans/product team and other areas for alignment and traceability.
• Supports requirement interpretation inconsistencies and related complaints.
• Self-organized reporting to keep leadership informed of work impact on financials.
• Engages operations leadership to review compliance-based issues for benefit planning.

Skills

Analytical skills

Problem-solving

Communication (oral & written)

Remote-work aware

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Microsoft Teams

Jira

Job description

JOB DESCRIPTION

Job Summary

Responsible for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable.

JOB DUTIES

• Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan developed requirements.
• Facilitates user acceptance testing; including creation of UAT scenarios and tracks defect management.
• Monitors sources to ensure all updates are aligned.
• Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations.
• Conducts analysis to identify root cause and assist with problem management as it relates to state requirements.
• Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices.
• Provides support for requirement interpretation inconsistencies and complaints.
• Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials.
• Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes.

KNOWLEDGE/SKILLS/ABILITIES

• Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation is agreed on and clear for solutioning.
• Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas.
• Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company.
• Ability to concisely synthesize large and complex requirements.
• Ability to organize and maintain regulatory data including real-time policy changes.
• Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems.
• Ability to work independently in a remote environment.
• Ability to work with those in other time zones than your own.

JOB QUALIFICATIONS

Required Qualifications

• At least 2 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience.
• Policy/government legislative review knowledge.
• Strong analytical and problem-solving skills.
• Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams.
• Previous success in a dynamic and autonomous work environment.

Preferred Qualifications

• Project implementation experience
• Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services(CMS) and the Affordable Care Act (ACA).
• Jira preferred
• Project Management Methodology exposure
• Care Management

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $44,936.59 - $97,362.61 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.