Regulatory Requirements Analyst (Remote)

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

Job summary

Molina Healthcare is seeking a regulatory requirements analyst to interpret and document coverage, reimbursement, and system-change requirements. You will coordinate with health plans, product teams, and governance committees to ensure alignment with regulatory baselines.

Responsibilities include monitoring updates, leading interpretation and traceability processes, performing root-cause analyses, and communicating findings to multiple stakeholders while maintaining compliance and timely

Qualifications

• At least 2 years of experience in a managed care organization or health insurance.
• Policy/government legislative review knowledge.
• Strong analytical and problem-solving skills.
• Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams.
• Power BI experience.

Responsibilities

• Develops and maintains requirement documents related to coverage and reimbursement and other system changes.
• Monitors sources to ensure updates are aligned with regulatory baseline requirements.
• Leads development and management of interpretation processes and governance with partner organizations.
• Conducts analysis to identify root cause and support state requirement alignment.
• Communicates interpretations and changes to health plans and product teams for alignment and traceability.
• Provides support for interpretation inconsistencies and complaints.
• Self-organized reporting to keep leadership aware of impact on financials.
• Engages with operations leadership to review compliance issues for benefit planning purposes.

Skills

Analytical skills

Problem-solving

Communication skills

Power BI

Tools

Word

Excel

Outlook

Teams

Job description

Molina Healthcare is seeking a regulatory requirements analyst to interpret and document coverage, reimbursement, and system-change requirements. You will coordinate with health plans, product teams, and governance committees to ensure alignment with regulatory baselines.

Responsibilities include monitoring updates, leading interpretation and traceability processes, performing root-cause analyses, and communicating findings to multiple stakeholders while maintaining compliance and timely