[Remote] Senior Business Analyst

Note: The job is a remote job and is open to candidates in USA. Molina Healthcare is a managed care organization, and they are seeking a Senior Business Analyst to provide senior level support for regulatory and functional requirements. This role involves coordinating with stakeholders, developing requirement documents, and ensuring alignment to regulatory standards and 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/product team developed requirements
• Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings
• Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational 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
• Where applicable, codifies the requirements for system configuration alignment and interpretation
• Provides support for requirement interpretation inconsistencies and complaints
• Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible
• 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
• Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product
• Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes

Skills

• At least 4 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
• Familiarity with administration systems
• 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

Benefits

• Molina Healthcare offers a competitive benefits and compensation package.

Company Overview

Company H1B Sponsorship