Analyst, Business - SQL (Remote in Florida)

Molina Talent Acquisition; Florida; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Benefits package

Job summary

Molina Healthcare seeks a Regulatory/Business Analyst to interpret coverage, reimbursement and related regulatory requirements. You will coordinate with health plans, product teams and governance committees to ensure alignment with regulatory baselines and plan requirements.

You will monitor updates, lead interpretation reviews, conduct root-cause analyses for state requirements, and communicate changes to stakeholders, ensuring traceability and timely compliance.

Qualifications

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

Responsibilities

• Develops and maintains requirement documents related to coverage, reimbursement and other system changes.
• Monitors sources to ensure updates are aligned.
• Leads coordinated development and interpretation review processes with partner organizations.
• Conducts analysis to identify root causes related to state requirements.
• Communicates requirement interpretations and changes to health plans and product teams.
• Provides support for requirement interpretation inconsistencies and complaints.
• Self-organized reporting to keep leadership aware of work efforts and impact of changes.
• Engages with operations leadership to review compliance-based issues for benefit planning.

Skills

Analytical skills

Problem-solving

Communication skills

Regulatory interpretation

Time management

SQL basics

Tools

Office Suite

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.
• 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

• Basic SQL knowledge is preferred.
• 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.