Reporting Analyst, SIU-(Remote)

Lensa; Nampa (ID); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is looking for a Reporting Analyst to join their Special Investigation Unit. This role will involve creating regulatory reports, interpreting compliance rules, and supporting audits to ensure adherence to state and federal regulations. You'll work closely with a dedicated team to mitigate fraud and waste issues, ensuring timely and accurate reporting. If you have a background in healthcare and a knack for analysis, this is a fantastic opportunity to make a meaningful impact in a dynamic environment.

Qualifications

• Minimum 2 years in SIU, law enforcement, healthcare, or regulatory fields.
• Experience in regulatory reporting and compliance preferred.

Responsibilities

• Create regulatory reports specific to the SIU and support compliance.
• Perform oversight audits to ensure adherence to laws and regulations.

Skills

Healthcare Experience

Proficiency in Excel

Regulatory Reporting

Analytical Skills

Education

Associate Degree

Tools

Healthcare Fraud Shield

Job description

1 day ago Be among the first 25 applicants

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 will ensure FWA referrals are logged, documented, assigned for investigation, and appropriately reported to state and federal regulators and/or law enforcement as appropriate. They will ensure that information is gathered and reported timely and accurately (monthly, quarterly, and annually). The role also includes overseeing designated SIU tracking systems. Duties may include peer reviews to ensure timely, accurate, and compliant reporting activities, and coordination with other departments to mitigate and address FWA issues.

Job Duties

1. The position is responsible for creating regulatory reports specific to the SIU, supporting contractual requirements, including reporting on overpayments identified and recovered, tips/leads received, investigative case activity, and other summary reports.
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 to ensure compliance with laws, regulations, contracts, and internal policies.
4. Support the SIU Manager, Director, and team in developing the Operational Oversight Program, including creating reports, triaging FWA complaints, assigning complaints, and demonstrating compliance across all Molina Healthcare Plans.
5. Manage and produce an inventory of regulatory reports.
6. Support external regulatory audits, including risk assessments, sample submissions, and providing requested documentation like 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 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 timely, accurate, and compliant reporting activities.
13. Qualifications include healthcare experience, proficiency in Excel, and preferred experience with Healthcare Fraud Shield.

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: 1+ years in regulatory reporting, 2-4 years in managed care, 3-5 years in healthcare regulatory, compliance, or auditing.

Physical Demands

Work environment is generally office-based with minimal hazards. Must be able to sit for long periods. Accommodations available for disabilities.

To apply, current Molina employees should use the intranet. Molina offers competitive benefits and is an Equal Opportunity Employer.

Pay Range: $21.82 - $51.06/hour. Compensation varies based on location, experience, education, and skills.

Additional Information

• Seniority level: Mid-Senior level
• Employment type: Contract
• Job function: Research, Analyst, IT
• Industries: IT Services and Consulting