Senior Analyst, Business (Enrollment)

Socket.dev; Long Beach (CA); On-site; USD 95,000 - 125,000; Full time

Benefits offered by this job

Competitive benefits package

Job summary

Molina Healthcare is seeking a senior analyst to provide expert support for business requirements activities related to coverage, reimbursement, and processing functions. This role supports the Enrollment CoE and focuses on improving enrollment processes and developing clear business requirements.

The ideal candidate will coordinate cross-functionally with stakeholders, monitor regulatory sources, and document interpretations for alignment and traceability across health plans and product teams.

Qualifications

• At least 4 years of operations/analyst experience in a managed care organization, health insurance setting or related field.
• Policy/government and legislative review knowledge.
• Analytical and problem-solving skills.
• Ability to synthesize large and complex requirements concisely.
• Experience creating reporting tools and providing project updates.
• Familiarity with administration systems.
• Ability to work in a matrixed, cross-functional environment.

Responsibilities

• Develops and maintains requirement documents related to coverage, reimbursement and system changes to align with regulatory and health plan requirements.
• Monitors regulatory sources to ensure updates are aligned.
• Documents unique specifications and navigates analytical problems.
• Supports governance processes and collaborates with partner organizations.
• Identifies changes to business processes and opportunities for improvements.
• Provides status updates to leadership and stakeholders.
• Communicates requirement interpretations to health plans/teams and coordinates meetings.
• Codifies requirements for system configuration as needed.
• Assists with development of requirement standards and best practices.
• Facilitates self-organized reporting on impact of changes for financials.
• Conducts industry research to deploy best practices.
• Coordinates with teams for analysis and implementation of changes.
• Reviews compliance-based issues with operational leadership.
• Ensures end-to-end business requirements are documented and clear.

Skills

Operations/analyst experience

Policy/government review

Analytical problem solving

Communication skills

Microsoft Office proficiency

Cross-functional collaboration

Tools

Microsoft Office

Job description

JOB DESCRIPTION Job Summary

Provides senior level analyst support for business requirements activities of high-level complexity. Responsible for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. Coordinates cross-functionally with stakeholders and subject matter experts to support business needs, and participates in governance committees as applicable.

This position supports the Enrollment CoE. The position will focus on improving enrollment processes and developing business requirements.

Essential Job Duties

• Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes to ensure alignment with regulatory and health plan/product requirements.
• Monitors regulatory sources to ensure all updates are aligned.
• Navigates analytical problems and clearly defines and documents unique specifications.
• Supports development and ongoing interpretation of review processes, committees and collaboration with key partner organizations.
• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.
• Provides status updates to health plan/product team partners, senior leadership and applicable stakeholders.
• Communicates requirement interpretations and changes to health plans/product teams and various impacted functional areas for requirement interpretation alignment and approval and solution traceability; coordinates meetings and champions/deploys operational process best practices.
• Where applicable, codifies the requirements for system configuration alignment and interpretation.
• Provides support and/or requirement interpretation inconsistencies and complaints.
• Assists with the development of requirement solution standards and best practices, and suggests improvement processes as applicable to consistently apply requirements across states and products.
• Facilitates self-organized reporting to ensure health plans/product teams, leaders, and applicable stakeholders are aware of work efforts and impact for prospective or retrospective requirement changes that impact financials.
• Conducts industry research and engagement to evaluate, provide insights, and develop/deploy best practices.
• Coordinates with applicable teams for analysis, impact and implementation of changes that impact health plan/product.
• Engages with operational leadership and health plan support functions to review compliance-based issues for benefit planning purposes.
• Ensures end-to-end business requirements are documented, interpretation is agreed upon, and solutioning is clear for all applicable parties.
• Develops and maintains relationships with health plan/product teams and corporate operations.
• Provides training and support to new and existing team members.

Required Qualifications

• At least 4 years of operations/analyst experience in a managed care organization, health insurance setting or related field, or equivalent combination of relevant education and experience.
• Policy/government and legislative review knowledge.
• Analytical and problem-solving skills.
• Ability to concisely synthesize large and complex requirements.
• Ability to organize and maintain regulatory data including real-time policy changes.
• Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems.
• Experience creating reporting tools/providing project/process updates.
• Familiarity with administration systems.
• Ability to work in a project team setting and complete individually assigned tasks within established timelines to meet desired deployment deadlines.
• Ability to work cross-functionally across a highly matrixed organization.
• Effective verbal, written and interpersonal communication skills, and ability to engage with stakeholders of all organizational levels.
• Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

• Project management/implementation experience.
• Health care experience.
• Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA).

• Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V