Reporting Analyst, SIU-(Remote)

Lensa; Rio Rancho (NM); Remote; Full time

Job summary

A leading career site is seeking a Reporting Analyst for Molina Healthcare's Special Investigation Unit. This role involves managing regulatory reports, ensuring compliance, and supporting audits. Ideal candidates have healthcare experience and proficiency in Excel. Competitive benefits offered.

Benefits

Competitive benefits

Qualifications

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

Responsibilities

• Creating regulatory reports specific to the SIU.
• Performing oversight audits to ensure compliance.
• Supporting external regulatory audits.

Skills

Healthcare experience

Proficiency in Excel

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/or law enforcement as appropriate. They will ensure that information is gathered and reported accurately and timely (monthly, quarterly, annually). The role includes oversight of SIU tracking systems. Duties may include peer reviews to ensure timely, accurate, and compliant reporting activities, and coordination with other departments to mitigate and remedy FWA.

Job Duties

• Creating regulatory reports specific to the SIU, including reports on overpayments, tips/leads, investigative activities, and summaries.
• Interpreting and analyzing regulatory rules, contracts, and guidance to assess compliance and support audit procedures.
• Performing oversight audits and validation activities to ensure legal and contractual compliance.
• Supporting the SIU team in developing the Operational Oversight Program, including report creation, complaint triage, and demonstrating regulatory compliance.
• Managing and producing regulatory reports.
• Supporting external regulatory audits, including risk assessments and submission of required documentation.
• Developing and communicating audit scope, objectives, and timelines in collaboration with stakeholders.
• Analyzing trend reports for compliance, performance, and training needs.
• Ensuring all regulatory reporting requirements are met to prevent non-compliance.
• Ensuring compliance with Molina Health Plans through report creation and execution.
• Serving as a backup to the Senior Reporting Analyst.
• Performing peer reviews for reporting activities.
• Possessing healthcare experience and proficiency in Excel; Healthcare Fraud Shield 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: Minimum 1 year in regulatory reporting; 2-4 years working in managed care; 3-5 years in healthcare regulatory, compliance, or auditing.

Physical Demands

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

Interested Molina employees should apply through the intranet. Molina offers competitive benefits. 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

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