Reporting Analyst, SIU-(Remote)

Lensa; Phoenix (AZ); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company in healthcare is seeking a Reporting Analyst for the Special Investigation Unit. This role involves creating regulatory reports, ensuring compliance, and supporting audits. Ideal candidates will have experience in healthcare and regulatory fields, with strong analytical skills.

Qualifications

• Minimum 2 years of experience in SIU, law enforcement, healthcare, or regulatory fields.
• 1+ years experience with regulatory reporting.

Responsibilities

• Create regulatory reports specific to the SIU.
• Perform oversight audits and validation activities.
• Ensure compliance with laws, regulations, contracts, and internal policies.

Skills

Excel

Compliance

Regulatory Reporting

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

Job Duties

1. The position is responsible for creating regulatory reports specific to the SIU, including reporting on overpayments identified and recovered, tips/leads received, investigative case activity, and other summaries.
2. Interprets and analyzes state and federal regulatory rules, contracts, and guidance to assess compliance and support regulatory audit procedures.
3. Performs oversight audits and validation activities to ensure compliance with laws, regulations, contracts, and internal policies.
4. Supports the SIU Manager, Director, and team in developing the Operational Oversight Program, including creating regulatory reports, FWA complaint intake triage, and demonstrating compliance across Molina Healthcare Plans.
5. Manages and produces their own inventory of regulatory reports.
6. Supports external regulatory audits by completing risk assessments, preparing sample universes, and submitting SOPs, requests for information, training materials, etc. (e.g., DMHC, CMS audits).
7. Develops and communicates audit scope, objectives, and timelines in collaboration with stakeholders.
8. Develops trend reports for compliance and performance improvement, and identifies training needs.
9. Ensures all regulatory reporting requirements for FWA notifications are met to avoid non-compliance.
10. Creates and executes reports to ensure compliance with all Molina Health Plans.
11. Serves as a backup to the Senior Reporting Analyst.
12. Performs peer reviews to ensure reporting accuracy and timeliness.
13. Requires 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 of experience in SIU, law enforcement, healthcare, or regulatory fields.

Preferred Experience

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

Physical Demands

Work is generally performed in an office environment with minimal exposure to hazards. Must be able to sit for long periods. Accommodations may be made for individuals with disabilities.

Interested Molina employees should apply through the intranet. Molina offers competitive benefits. EOE M/F/D/V.

Pay Range: $21.82 - $51.06/hour. Actual pay may vary based on location, experience, education, and skills.

Additional Details

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