Reporting Analyst, SIU-(Remote)

Lensa; Santa Fe (NM); Remote; Full time

Job summary

A leading company is seeking a Reporting Analyst for the Special Investigation Unit (SIU). The role involves creating regulatory reports, ensuring compliance, and supporting audits. Candidates should have healthcare experience and proficiency in Excel. This mid-senior level position offers competitive benefits.

Benefits

Competitive benefits

Qualifications

• Minimum 2 years experience in SIU, law enforcement, healthcare, or regulatory fields.

Responsibilities

• Creating regulatory reports specific to the SIU.
• Performing oversight audits and validation activities.
• Ensuring compliance with all Molina Health Plans.

Skills

Healthcare experience

Proficiency in Excel

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 law enforcement as appropriate. Ensures that relevant information is gathered and reported timely and accurately. Provides oversight of designated SIU tracking systems. Duties may include performing peer reviews to ensure reporting and triage activities are timely, accurate, and compliant with Molina Healthcare requirements, and coordinating with other departments to mitigate and remedy FWA issues.

Job Duties (Main Responsibilities)

1. Creating regulatory reports specific to the SIU, including overpayments identified and recovered, tips/leads received, investigative case activity, and other summary reports.
2. Interpreting and analyzing state and federal 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 internal policies.
4. Supporting the SIU Manager, Director, and team in developing the Operational Oversight Program, including creating regulatory reports, triaging FWA complaints, and ensuring regulatory compliance across Molina Healthcare Plans.
5. Managing and producing their own inventory of regulatory reports.
6. Supporting health plans and MHI Business Owners with external regulatory audits, including risk assessments, sample submissions, and providing evidence such as SOPs and training materials.
7. Developing and communicating audit scope, objectives, and timelines in collaboration with stakeholders.
8. Developing trend reports for compliance, performance improvement, and training needs.
9. Ensuring all regulatory reporting requirements for FWA notifications are met to prevent 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 to ensure reporting activities are timely, accurate, and compliant.
13. Healthcare experience and proficiency in Excel are required; Healthcare Fraud Shield is preferred.

Job Qualifications

Required Education

Associate Degree or equivalent combination of education and experience.

Required Experience/Skills

Minimum 2 years 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 adequate lighting and temperature. Must be able to sit for long periods. Reasonable accommodations are available for individuals with disabilities.

Interested employees should apply through the intranet. Molina Healthcare 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