Analyst, Business
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