Analyst, Business (Remote)

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

Job summary

Molina Healthcare is seeking a qualified professional to interpret regulatory and functional requirements for coverage, reimbursement, and processing changes in support of systems solutions development. The role involves coordinating with stakeholders and governance committees to ensure alignment and timely delivery.

The successful candidate will analyze state requirements, communicate interpretations across product teams, and support governance processes while working independently in a remote

Qualifications

• At least 2 years of experience in a managed care organization, health insurance or related field.
• Policy/government legislative review knowledge.
• Strong analytical and problem-solving skills.
• Proficient in Word, Excel, Outlook and Teams.
• Experience in a dynamic, autonomous work environment.
• Experience with Power BI.

Responsibilities

• Develops and maintains requirement documents for coverage, reimbursement and system changes.
• Monitors sources to ensure updates align with regulatory baselines.
• Leads collaborative development and governance reviews with partner organizations.
• Performs root-cause analysis and supports problem management for state requirements.
• Communicates interpretations and changes to health plans and product teams for alignment.
• Provides support for interpretation inconsistencies and complaints.
• Self-organizes reporting to keep leadership informed of impact and work efforts.
• Engages with operations and Plan Support to review compliance issues for benefit planning.

Skills

Analytical skills

Communication skills

Problem-solving

Time management

Independent work

Tools

Power BI

MS Office Suite

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 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.

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.
• Power BI

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

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.