Reporting Analyst, SIU-(Remote)

Lensa; Layton (UT); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization is seeking a Reporting Analyst for their Special Investigation Unit. The role involves creating regulatory reports, ensuring compliance with laws, and performing audits. Ideal candidates will have experience in SIU or healthcare regulatory fields, and proficiency in Excel is essential.

Benefits

Competitive benefits

Qualifications

• Minimum 2 years in SIU, law enforcement, healthcare, or regulatory fields.
• At least 1 year in regulatory reporting preferred.
• 2-4 years in managed care and 3-5 years in healthcare regulatory, compliance, or auditing preferred.

Responsibilities

• Create regulatory reports specific to the SIU.
• Perform oversight audits and validation activities for compliance.
• Support SIU management in developing the Operational Oversight Program.

Skills

Healthcare experience

Proficiency in Excel

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 will ensure FWA referrals are logged, documented, assigned for investigation, and appropriately reported to state and federal regulators and law enforcement as needed. They ensure that information is gathered and reported timely and accurately, and 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 the SIU, including overpayments, tips/leads, case activity, 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 compliance with laws, regulations, contracts, and policies.
4. Support SIU management in developing the Operational Oversight Program, including report creation, complaint triage, and regulatory compliance demonstration.
5. Manage and produce a personal inventory of regulatory reports.
6. Support external regulatory audits by completing risk assessments, preparing sample universes, and submitting requested documentation.
7. Develop and communicate audit scope, objectives, and timelines in collaboration with stakeholders.
8. Develop trend reports for compliance and performance improvement, 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 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 experience.

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

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

Physical Demands

Work is performed in an office environment with minimal hazards. Must be able to sit for long periods; accommodations available for disabilities.

Interested current Molina employees should apply through the intranet.

Molina Healthcare offers competitive benefits. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $21.82 - $51.06 hourly. 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