Analyst, Business - Advanced Excel (Remote in MI)

Molina Healthcare; Lansing (MI); Remote; USD 65,000 - 90,000; Full time

Job summary

Molina Healthcare, Inc. is seeking a business requirements analyst to support regulatory and functional requirements related to coverage, reimbursement, and processing functions.

The role coordinates with stakeholders, documents complex specifications, and ensures alignment with health plan requirements. Ideal candidates bring advanced Excel skills, at least 2 years in a managed care/health insurance setting, and CBAP certification.

Qualifications

• Advanced Excel skills.
• At least 2 years of operations/analyst experience in a managed care organization or health insurance setting.
• Policy/government and legislative review knowledge.
• Experience creating reporting tools and providing project updates.
• Ability to work in a project team and meet deployment deadlines.
• CBAP certification.

Responsibilities

• Interpret and document regulatory and/or functional requirements for coverage, reimbursement, and processing.
• Coordinate with stakeholders and SMEs and participate in governance committees.
• Develop and maintain requirement documents ensuring alignment with regulatory and health plan requirements.
• Provide status updates to leadership and stakeholders.
• Communicate requirement interpretations and changes across teams for alignment and traceability.
• Codify requirements for system configuration alignment where applicable.
• Support requirement interpretation issues and complaints.
• Facilitate self-organized reporting for awareness of work impact on financials.
• Coordinate with teams for analysis, impact and implementation of changes affecting health plan.
• Engage with operational leadership to review compliance issues for benefit planning.
• Ensure end-to-end business requirements are documented and understood by all parties.
• Develop and maintain relationships with health plan/product teams and corporate operations.

Skills

Advanced Excel

Analytical thinking

Project coordination

Communication skills

Education

CBAP Certification

Tools

Microsoft Office

Job description

Provides analyst support for business requirements activities of moderate complexity. 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. Coordinates cross-functionally with stakeholders and subject matter experts to support business needs, and participates in governance committees as applicable.

This position requires advanced Excel skills. Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes to ensure alignment with regulatory and health plan/product requirements.

• Monitors regulatory sources to ensure all updates are aligned.
• Navigates analytical problems and clearly defines and documents unique specifications.
• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.
• Provides status updates to health plan/product team partners, senior leadership and applicable stakeholders.
• Communicates requirement interpretations and changes to health plans/product teams and various impacted functional areas for requirement interpretation alignment and approval and solution traceability; Where applicable, codifies the requirements for system configuration alignment and interpretation.
• Provides support and/or requirement interpretation inconsistencies and complaints.
• Facilitates self-organized reporting to ensure health plans/product teams, leaders, and applicable stakeholders are aware of work efforts and impact for prospective or retrospective requirement changes that impact financials.
• Coordinates with applicable teams for analysis, impact and implementation of changes that impact health plan/product.
• Engages with operational leadership and health plan support functions to review compliance-based issues for benefit planning purposes.
• Ensures end-to-end business requirements are documented, interpretation is agreed upon, and solutioning is clear for all applicable parties.
• Develops and maintains relationships with health plan/product teams and corporate operations.

At least 2 years of operations/analyst experience in a managed care organization, health insurance setting or related field, or equivalent combination of relevant education and experience.

• Policy/government and legislative review knowledge.
• Ability to organize and maintain regulatory data including real-time policy changes.
• Experience creating reporting tools/providing project/process updates.
• Ability to work in a project team setting and complete individually assigned tasks within established timelines to meet desired deployment deadlines.
• Microsoft Office suite and applicable software programs proficiency.
• Project management/implementation experience.
• Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA).
• Certified Business Analysis Professional (CBAP).