Note: The job is a remote job and is open to candidates in USA. Molina Healthcare is hiring a Business Analyst to interpret regulatory and functional requirements related to coverage, reimbursement, and processing. The role supports systems development and maintenance through requirements documentation, stakeholder coordination, testing, and ongoing requirement management.

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

Skills

• 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
• 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
• 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

Company Overview

Company H1B Sponsorship