About this role
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.
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).
- 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