Analyst, Business

Molina Healthcare is a managed care organization focused on providing quality healthcare services. The Analyst, Business role is responsible for the intake and interpretation of regulatory requirements to support systems solutions development and maintenance, 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
• 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

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
• 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