Business Analyst

Molina Healthcare is a managed care organization, and they are seeking a Business Analyst to support systems solutions development and maintenance. The role involves interpreting regulatory requirements, coordinating with stakeholders, and ensuring compliance with health plan requirements.

Responsibilities:

• 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 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

Requirements:

• 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
• 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