Molina HealthcareRemote
Business Analyst (Healthcare A&G)
United States of America
Full-time
1 week ago
$45,000 - $97,000 USD
H1B Sponsor Likely
Key skills
Managed care experiencePolicy review knowledgeAnalytical skillsOffice Product SuiteProject implementationCMS knowledgeMedical Coding certificationTime zone collaborationJiraAppeals & GrievancesInterpersonal skillsCommunication skillsProblem-solving skillsSelf-motivatedLeadership
About this role
Molina Healthcare is a managed care organization focused on providing healthcare services. They are seeking a Business Analyst to interpret regulatory requirements within Appeals & Grievances, ensuring alignment with coverage and reimbursement processes while coordinating with stakeholders.
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
- Jira
- Appeals & Grievances