Reporting Analyst, SIU-(Remote)

Lensa; Vancouver (WA); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization is seeking a Reporting Analyst for their Special Investigation Unit. This role involves creating regulatory reports, ensuring compliance, and supporting audits. Ideal candidates will have healthcare experience and proficiency in Excel. Join a dynamic team committed to preventing fraud and ensuring regulatory adherence.

Benefits

Competitive Benefits

Qualifications

• Minimum 2 years in SIU, law enforcement, healthcare, or regulatory fields.
• 1+ year in regulatory reporting preferred.

Responsibilities

• Create regulatory reports specific to SIU, including overpayment recoveries.
• Perform oversight audits to ensure compliance with laws and regulations.
• Develop trend reports for compliance and performance improvement.

Skills

Healthcare Experience

Proficiency in Excel

Education

Associate Degree

Job description

4 days 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 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, peer reviews for reporting accuracy, and coordination with other departments to mitigate FWA issues.

Job Duties

• Create regulatory reports specific to SIU, including overpayment recoveries, tips/leads, case activity, and summary reports.
• Interpret and analyze regulatory rules, contracts, and guidance to ensure compliance and support audit procedures.
• Perform oversight audits and validation activities to ensure compliance with laws, regulations, contracts, and policies.
• Support the SIU Manager and team in developing the Operational Oversight Program, including report creation, complaint triage, and regulatory compliance demonstration.
• Manage and produce regulatory reports independently.
• Assist with external regulatory audits, including risk assessments, sample submissions, and documentation.
• Develop and communicate audit scope, objectives, and timelines with stakeholders.
• Develop trend reports for compliance and performance improvement, identifying training needs.
• Ensure all regulatory reporting requirements for FWA are met to prevent non-compliance.
• Ensure compliance with Molina Health Plans through report creation and execution.
• Serve as a backup to the Senior Reporting Analyst.
• Perform peer reviews to ensure timely and accurate reporting.
• Possess 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

• 1+ year in regulatory reporting.
• 2-4 years working in managed care organizations.
• 3-5 years in healthcare regulatory, compliance, or auditing roles.

Physical Demands

Work in a generally favorable environment, sitting for long periods, with accommodations possible for disabilities.

Interested Molina employees should apply through the intranet. Molina offers competitive benefits. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $21.82 - $51.06/hourly. 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