Reporting Analyst, SIU-(Remote)

Lensa; Caldwell (ID); Remote; Full time

Job summary

A leading healthcare organization is seeking a Reporting Analyst for their Special Investigation Unit. This role involves creating regulatory reports, ensuring compliance with laws, and supporting audits. Ideal candidates will have healthcare experience and proficiency in Excel. Join a team dedicated to maintaining compliance and supporting healthcare integrity.

Benefits

Competitive Benefits

Qualifications

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

Responsibilities

• Create regulatory reports specific to the SIU.
• Perform oversight audits to ensure regulatory compliance.
• Support external regulatory audits and risk assessments.

Skills

Excel

Healthcare Experience

Education

Associate Degree

Job description

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Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

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/or law enforcement as appropriate. Ensures that timely and accurate information is gathered and reported. Provides oversight of designated SIU tracking systems. Duties include peer reviews to ensure activities are timely, accurate, and compliant, and coordination with other departments to mitigate and remedy FWA.

Job Duties

1. Responsible for creating regulatory reports specific to the SIU, including reports on overpayments, tips/leads, investigative activities, and summaries.
2. Interpret and analyze regulatory rules, contracts, and guidance to assess compliance and support audit procedures.
3. Perform oversight audits and validation activities to ensure regulatory compliance with laws, regulations, and policies.
4. Support SIU management in developing the Operational Oversight Program, including creating reports, triaging FWA complaints, and ensuring compliance across plans.
5. Manage and produce regulatory reports.
6. Support external regulatory audits, including risk assessments and document submissions (e.g., DMHC, CMS audits).
7. Develop and communicate audit scope, objectives, and timelines in collaboration with stakeholders.
8. Develop trend reports to ensure compliance and identify training needs.
9. Ensure all regulatory reporting requirements for FWA are met to avoid non-compliance.
10. Ensure compliance with Molina Health Plans through report creation and execution.
11. Serve as a backup to the Senior Reporting Analyst.
12. Perform peer reviews for reporting accuracy and timeliness.
13. 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 working in managed care organizations.
• 3-5 years in healthcare regulatory, compliance, or auditing roles.

Physical Demands

Office environment, sitting for long periods, minimal exposure to hazards. Reasonable accommodations provided for disabilities.

Interested Molina employees should apply through the intranet. Molina offers competitive benefits. Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $21.82 - $51.06/hour. Actual pay varies based on location, experience, education, and skills.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Contract
• Job function: Research, Analyst, IT
• Industries: IT Services and Consulting