Reporting Analyst, SIU-(Remote)

Lensa; Grand Island (NE); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading career site is seeking a Reporting Analyst for Molina Healthcare. This role involves supporting the Special Investigation Unit by ensuring compliance with regulatory reporting requirements and conducting audits. Ideal candidates will have healthcare experience and proficiency in Excel, along with relevant educational qualifications.

Benefits

Competitive benefits

Qualifications

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

Responsibilities

• Create regulatory reports specific to the SIU.
• Support health plans during external regulatory audits.

Skills

Healthcare experience

Proficiency in Excel

Regulatory compliance

Education

Associate Degree or equivalent experience

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 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 timely and accurately (monthly, quarterly, annually). They oversee designated SIU tracking systems. Duties may include peer reviews to ensure timely, accurate, compliant reporting, and coordination with other departments to mitigate and remedy FWA.

Job Duties

1. Create regulatory reports specific to the SIU, including overpayments identified and recovered, tips/leads received, investigative case activity, and other summaries.
2. Interpret and analyze state and federal regulatory rules, contracts, and guidance to assess compliance and support regulatory audit procedures.
3. Perform oversight audits and validation activities under management’s direction to ensure compliance with laws, regulations, contracts, and policies.
4. Support the SIU Manager, Director, and team in developing the Operational Oversight Program, including report creation, FWA complaint triage, complaint assignment, and demonstrating regulatory compliance.
5. Manage and produce their own inventory of regulatory reports.
6. Support health plans and MHI Business Owners during external regulatory audits, including risk assessments, sample submissions, and providing requested documentation.
7. Develop and communicate audit scope, objectives, and timelines in collaboration with stakeholders.
8. Develop and analyze trend reports to ensure compliance and identify training needs.
9. Ensure all regulatory reporting requirements for FWA are met to prevent non-compliance.
10. Ensure compliance with all Molina Health Plans through report creation and execution.
11. Serve as a backup to the Senior Reporting Analyst.
12. Perform peer reviews for reporting activities.
13. Possess 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 Experience: 1+ years in regulatory reporting; 2-4 years in managed care; 3-5 years in healthcare-related fields (Regulatory, Compliance, Auditing).

Physical Demands

Work environment is generally office-based with adequate lighting and temperature. Must be able to sit for long periods. Accommodations available for disabilities.

Interested current Molina employees should apply through the intranet. Molina offers competitive benefits. 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