Reporting Analyst, SIU-(Remote)

Lensa; Green Bay (WI); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading career site is seeking a Reporting Analyst for Molina Healthcare in Green Bay. This role involves supporting the Special Investigation Unit by ensuring accurate regulatory reporting and compliance with state and federal regulations. Ideal candidates will have healthcare experience and proficiency in Excel, along with a strong background in regulatory reporting.

Qualifications

• Minimum 2 years in SIU, law enforcement, healthcare, or regulatory field.
• 1+ years in regulatory reporting preferred.
• 2-4 years working for a managed care organization is a plus.

Responsibilities

• Create regulatory reports specific to SIU.
• Perform oversight audits to ensure compliance.
• Develop trend reports to ensure compliance and identify training needs.

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 law enforcement as needed. They ensure timely and accurate gathering and reporting of information to regulators (monthly, quarterly, annually). They oversee designated SIU tracking systems. Duties include performing peer reviews to ensure timely, accurate, and compliant reporting activities, and coordinating with other departments to mitigate and address FWA issues.

Job Duties

1. Create regulatory reports specific to SIU, including overpayments, tips/leads, investigation activities, and summary reports.
2. Interpret and analyze state and federal regulatory rules, contracts, and guidance to assess compliance and support audit procedures.
3. Perform oversight audits and validation activities to ensure compliance with laws, regulations, contracts, and internal policies.
4. Support SIU management in developing the Operational Oversight Program, including creating reports, triaging FWA complaints, and demonstrating regulatory compliance.
5. Manage and produce regulatory reports inventory.
6. Assist health plans and MHI Business Owners with external regulatory audits, including risk assessments and submission of documentation.
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 notifications 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 to ensure 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 combination of education and experience.

Required Experience/Skills

Minimum 2 years in SIU, law enforcement, healthcare, or regulatory field.

Preferred Experience

• 1+ years in regulatory reporting.
• 2-4 years working for a managed care organization.
• 3-5 years in healthcare, compliance, or auditing (desired).

Physical Demands

Work is performed in an office environment with adequate lighting and temperature. Must be able to sit for long periods. Accommodations available for disabilities.

Current Molina employees interested in this position should apply through the intranet.

Molina Healthcare offers competitive benefits and compensation. We are an 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

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