Reporting Analyst, SIU-(Remote)

Lensa; Madison (WI); 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 compliance with regulatory requirements, creating reports, and supporting audits. Ideal candidates will have healthcare experience and proficiency in Excel. Join a dynamic team focused on preventing fraud and ensuring regulatory compliance.

Qualifications

• Minimum 2 years in SIU, law enforcement, healthcare, or regulatory field.
• Minimum 1 year in regulatory reporting; 2-4 years in managed care organizations.

Responsibilities

• Create regulatory reports specific to the SIU, including overpayments and investigative activity.
• Perform oversight audits and validation activities to ensure compliance with laws and regulations.
• Support external regulatory audits by preparing and submitting requested documentation.

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 law enforcement as needed. They will ensure timely and accurate gathering and reporting of information, oversee designated SIU tracking systems, and perform peer reviews to ensure activities are compliant with Molina Healthcare requirements. Responsibilities include coordinating with other departments to mitigate and remedy FWA.

Job Duties

1. Create regulatory reports specific to the SIU, including overpayments, tips/leads, investigative activity, and other 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 the SIU Manager and team in developing the Operational Oversight Program, including creating reports, triaging FWA complaints, and demonstrating regulatory compliance.
5. Manage and produce regulatory reports inventory.
6. Support external regulatory audits by preparing and submitting requested documentation, such as audit risk assessments, sample universes, SOPs, and training materials.
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 timely, accurate, and compliant reporting activities.
13. Healthcare experience and proficiency in Excel are required; 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

Minimum 1 year in regulatory reporting; 2-4 years in managed care organizations; 3-5 years in healthcare regulatory, compliance, or auditing fields.

Physical Demands

Standard office environment, minimal hazards, ability to sit for long periods, accommodations available for disabilities.

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

Pay Range: $21.82 - $51.06/hour. Compensation 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