JOB DESCRIPTION Job Summary
Provides analyst support for business requirements activities of moderate
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 requires advanced Excel skills. Please update your resume with
any relevant experience.
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.
Required Qualifications
• At least 2 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).
• Certified Business Analysis Professional (CBAP).
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