Analyst, Business

Molina Healthcare is seeking a Business Analyst to support the interpretation and management of regulatory and functional requirements related to healthcare coverage, reimbursement, and processing systems. The role coordinates with stakeholders, facilitates user acceptance testing, analyzes regulatory issues, and communicates requirement changes to support compliant system solutions and benefit planning.

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

Facilitates user acceptance testing; including creation of UAT scenarios and tracks defect management

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

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

Preferred

• Project implementation experience
• Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA)
• Jira preferred
• Project Management Methodology exposure
• Care Management

Project Implementation

Federal Regulatory Policy

CMS Knowledge

ACA Knowledge

Jira

Project Management Methodology

Care Management

Benefits

Ability to work independently in a remote environment

Company

Government-sponsored health plans for families and individuals

Long Beach, California, USA

https://investors.molinahealthcare.com/

Founded in 1980

10001+ employees

Qualifications

• 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
• 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)
• Jira preferred
• Project Management Methodology exposure
• Care Management
• 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.

Required skills

Managed Care, Health Insurance, Policy and Government Legislative Review, Microsoft Office Suite, Project Implementation, CMS Regulatory Policy, Affordable Care Act (ACA), Jira, Care Management

Preferred skills

• Project implementation experience, • Jira preferred, • Project Management Methodology exposure, • Care Management

Experience

2+ years