Reporting Analyst, SIU-(Remote)

Lensa; Buffalo (NY); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading career site is seeking a Reporting Analyst for Molina Healthcare's Special Investigation Unit. The role involves ensuring accurate reporting of fraud, waste, and abuse (FWA) cases, regulatory compliance, and oversight of tracking systems. Ideal candidates will have healthcare experience and proficiency in Excel, with opportunities for professional growth.

Qualifications

• Minimum 2 years in SIU, law enforcement, healthcare, or regulatory fields.
• 1+ years in regulatory reporting preferred.

Responsibilities

• Create regulatory reports for the SIU.
• Perform oversight audits to ensure compliance.
• Assist with external regulatory audits.

Skills

Healthcare Experience

Proficiency in Excel

Education

Associate Degree

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 ensures FWA referrals are logged, documented, assigned for investigation, and appropriately reported to state and federal regulators and/or law enforcement as appropriate. They ensure that relevant information is gathered and reported accurately and timely (monthly, quarterly, and annually). The role also involves oversight of designated SIU tracking systems. Duties may include peer reviews to ensure timely and accurate reporting activities in compliance with Molina Healthcare requirements, and coordination with other departments to mitigate and remedy FWA issues.

Job Duties (Main Responsibilities)

• Create regulatory reports specific to the SIU, supporting contractual requirements, including reporting on overpayments identified and recovered, tips/leads received, investigative case activity, and other summary reports.
• Interpret and analyze state and federal regulatory rules, contracts, and guidance to assess compliance and support audit procedures.
• Perform oversight audits and validation activities to ensure compliance with laws, regulations, contracts, and policies.
• Support the SIU Manager, Director, and team in developing the Operational Oversight Program, including regulatory reporting, FWA complaint intake triage, assigning complaints, and demonstrating compliance across all Molina Healthcare Plans.
• Manage and produce an inventory of regulatory reports.
• Assist health plans and MHI Business Owners with external regulatory audits, including risk assessments, sample submissions, and providing documentation such as SOPs, training materials, and evidence.
• Develop and communicate audit scope, objectives, and timelines in collaboration with stakeholders.
• Develop and analyze trend reports for compliance and performance improvement, and identify training needs.
• Ensure all regulatory reporting requirements for state and federal FWA notifications are met to prevent non-compliance.
• Ensure compliance with all Molina Health Plans through report creation and execution.
• Serve as a backup to the Senior Reporting Analyst.
• Perform peer reviews to ensure reporting accuracy and timeliness.
• Possess healthcare experience and proficiency in Excel; healthcare Fraud Shield experience is preferred.

Job Qualifications

Required Education: Associate Degree or equivalent experience.

Required Experience/Skills: Minimum 2 years in SIU, law enforcement, healthcare, or regulatory fields.

Preferred Experience: 1+ years in regulatory reporting; 2-4 years in managed care; 3-5 years in healthcare regulatory, compliance, or auditing.

Physical Demands

The work environment is generally office-based with adequate lighting and temperature. Must be able to sit for long periods. Accommodations may be provided for disabilities.

Interested Molina employees should apply through the intranet. Molina offers competitive benefits and is an Equal Opportunity Employer. Pay range: $21.82 - $51.06/hour.