Senior Analyst, Business (Remote)
About The Position
Job Summary Provides senior level support 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. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. Where applicable, codifies the requirements for system configuration alignment and interpretation. Provides support for requirement interpretation inconsistencies and complaints. Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes.
Requirements
- At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience.
- Policy/government legislative review knowledge
- Strong analytical and problem-solving skills
- Familiarity with administration systems
- Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams
- Previous success in a dynamic and autonomous work environment
Nice To Haves
- Project implementation experience
- Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA).
- Medical Coding certification.
Responsibilities
- Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements.
- Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings.
- Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations.
- Interpret customer business needs and translate them into application and operational requirements.
- Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices.
- Where applicable, codifies the requirements for system configuration alignment and interpretation.
- Provides support for requirement interpretation inconsistencies and complaints.
- Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible.
- Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials.
- Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product.
- Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes.
Benefits
- Molina Healthcare offers a competitive benefits and compensation package.
- Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
