Reporting Analyst, SIU-(Remote)

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

Job summary

A leading healthcare company is seeking a Reporting Analyst for their Special Investigation Unit (SIU). This role involves creating regulatory reports, ensuring compliance, and supporting audits. Candidates should have healthcare experience and proficiency in Excel, with a focus on regulatory reporting.

Benefits

Competitive benefits

Qualifications

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

Responsibilities

• Creating regulatory reports specific to the SIU.
• Performing oversight audits and validation activities.
• Supporting external regulatory audits.

Skills

Healthcare experience

Proficiency in Excel

Education

Associate Degree or equivalent experience

Tools

Healthcare Fraud Shield

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, SIU 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 information is gathered and reported timely and accurately (monthly, quarterly, annually). They oversee designated SIU tracking systems. Duties include performing peer reviews to ensure reporting and triage activities are timely, accurate, and compliant, and coordinating with other departments to mitigate and remedy FWA.

Job Duties

1. Creating regulatory reports specific to the SIU, including overpayments, tips/leads, investigative case activity, and summary reports.
2. Interpreting and analyzing regulatory rules, contracts, and guidance to assess compliance and support audit procedures.
3. Performing oversight audits and validation activities to ensure compliance with laws, regulations, contracts, and policies.
4. Supporting the SIU Manager and team in developing the Operational Oversight Program, including report creation, complaint triage, and demonstrating regulatory compliance.
5. Managing and producing regulatory reports.
6. Supporting external regulatory audits, including risk assessments and submission of information.
7. Developing and communicating audit scope, objectives, and timelines.
8. Developing trend reports for compliance and performance improvement, and identifying training needs.
9. Ensuring all regulatory reporting requirements for FWA are met to avoid non-compliance.
10. Ensuring compliance with all Molina Health Plans through report creation and execution.
11. Serving as a backup to the Senior Reporting Analyst.
12. Performing peer reviews for reporting accuracy and timeliness.
13. Healthcare experience required.
14. Proficiency in Excel required.
15. Healthcare Fraud Shield experience 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 regulatory, compliance, or auditing.

Physical Demands

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

Interested 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/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