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.
Facilitates user acceptance testing; including creation of UAT scenarios and
tracks defect management.
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
as it relates to state 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.
Provides support for requirement interpretation inconsistencies and
complaints.
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.
Engages with operations leadership and Plan Support functions to review
compliance-based issues for benefit planning purposes.
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.
Policy/government legislative review knowledge.
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).
Jira preferred
Project Management Methodology exposure
Care Management
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.