Reporting Analyst, SIU-(Remote)

Lensa; Akron (OH); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company in IT Services is seeking a Reporting Analyst to support their Special Investigation Unit. The role involves creating regulatory reports, ensuring compliance with laws, and coordinating with departments to address fraud issues. Ideal candidates will have healthcare experience and proficiency in Excel.

Benefits

Competitive benefits

Qualifications

• Minimum 2 years in SIU, law enforcement, healthcare, or regulatory fields.
• Preferred: 1+ years regulatory reporting experience, 2-4 years in managed care, 3-5 years in healthcare compliance.

Responsibilities

• Creating regulatory reports specific to the SIU.
• Performing oversight audits and validation activities.
• Managing and producing regulatory reports.

Skills

Healthcare experience

Proficiency in Excel

Regulatory compliance

Education

Associate Degree or equivalent experience

Job description

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Job Description

Job Summary

Under the direct supervision of the Manager, the Reporting Analyst, SIU supports a team in the Special Investigation Unit (SIU). The Reporting Analyst will ensure FWA referrals are logged, documented, assigned for investigation, and appropriately reported to state and federal regulators and law enforcement as needed. They will ensure timely and accurate gathering and reporting of information, oversee designated SIU tracking systems, and perform peer reviews to ensure timely, accurate, and compliant reporting activities. The role involves coordination with other departments to mitigate and remedy FWA issues.

Job Duties

1. Creating regulatory reports specific to the SIU, including reports on overpayments, tips/leads, investigative activities, and summaries.
2. Interpreting and analyzing regulatory rules, contracts, and guidance to assess compliance and support audit procedures.
3. Performing oversight audits and validation activities to ensure compliance with laws, regulations, contracts, and internal policies.
4. Supporting the SIU Manager and team in developing the Operational Oversight Program, including report creation, complaint triage, and demonstrating regulatory compliance.
5. Managing and producing regulatory reports.
6. Supporting external regulatory audits by preparing risk assessments, sample universes, SOPs, and other documentation.
7. Developing and communicating audit scope, objectives, and timelines in collaboration with stakeholders.
8. Developing trend reports for compliance and performance improvement, and identifying training needs.
9. Ensuring MHI meets all regulatory reporting requirements for FWA notifications.
10. Ensuring compliance with all Molina Health Plans through report creation and execution.
11. Serving as a backup to the Senior Reporting Analyst.
12. Performing peer reviews to ensure reporting accuracy and timeliness.
13. Possessing healthcare experience and proficiency in Excel; Healthcare Fraud Shield experience is preferred.

Job Qualifications

Required Education: Associate Degree or equivalent experience.

Experience/Skills: Minimum 2 years in SIU, law enforcement, healthcare, or regulatory fields. Preferred: 1+ years regulatory reporting experience, 2-4 years in managed care, 3-5 years in healthcare compliance, auditing.

Physical Demands

Work is generally in an office environment with adequate lighting and temperature. Must be able to sit for long periods. Reasonable accommodations are available for individuals with disabilities.

Additional Information

Interested Molina employees should apply through the intranet. Molina offers competitive benefits. Equal Opportunity Employer. Pay range: $21.82 - $51.06/hour, varies by location and experience.

Additional Details

• Seniority Level: Mid-Senior level
• Employment Type: Contract
• Job Function: Research, Analyst, IT
• Industries: IT Services and Consulting