Analyst, Business

Molina Healthcare; United States; On-site; USD 45,000 - 97,000; Full time

Job summary

Molina Healthcare is seeking a Regulatory and Requirements Analyst to ensure accurate, timely intake and interpretation of regulatory and functional requirements related to coverage, reimbursement, and processing functions to support systems solutions development and maintenance.

This role requires coordinating with stakeholders and subject matter experts on partnering teams, supporting governance committees, conducting root-cause analysis, and communicating interpretations to health plans,

Qualifications

• At least 2 years of experience in a managed care organization or health insurance context.

Responsibilities

• Develops and maintains requirement documents related to coverage, reimbursement and system changes.

Skills

Analytical thinking

Problem solving

Regulatory knowledge

Communication skills

Remote work ability

Multitasking

Office suite proficiency

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Microsoft Teams

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 Description

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.
• 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.
• 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.
• Self-organized reporting to ensure 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.
• Builds Virtual Instructor-Led Training (VILT) sessions in the Learning Management System (LMS).
• Supports intake triage, scheduling logistics, and report reconciliation activities.
• Identifies and applies automation and AI tools to improve processes, streamline workflows, and increase efficiency in training operations and related support activities.

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.
• 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).
• Medical Coding certification.

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.