Description
JOB DESCRIPTION
Job Summary
- 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.
- 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 developed requirements.
- Monitors sources to ensure all updates are aligned.
- Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations.
- Conducts analysis to identify root cause and assist with problem management.
- 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.
- Self-organized reporting to ensure leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials.
- Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes.
- Builds Virtual Instructor-Led Training (VILT) sessions in the Learning Management System (LMS).
- Supports intake triage, scheduling logistics, and report reconciliation activities.
- Identifies and applies automation and AI tools to improve processes, streamline workflows, and increase efficiency in training operations and related support activities.
KNOWLEDGE/SKILLS/ABILITIES
- Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation is agreed on and clear for solutioning.
- Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas.
- Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company.
- 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.
- Ability to work independently in a remote environment.
- Ability to work with those in other time zones than your own.
JOB QUALIFICATIONS
Required Qualifications
- At least 2 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.
- Strong analytical and problem-solving skills.
- Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams.
- Previous success in a dynamic and autonomous work environment.
Preferred Qualifications
- 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.
To all current Molina employees
- If you are interested in applying for this position, please apply through the Internal Job Board.
- Molina Healthcare offers a competitive benefits and compensation package.
- Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V